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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270336
Report Date: 02/03/2020
Date Signed: 02/03/2020 03:16:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
304270336
ADMINISTRATOR:VALDEZ, SHANNONFACILITY TYPE:
840
ADDRESS:30075 ALICIA PARKWAYTELEPHONE:
(949) 249-2321
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:28CENSUS: 0DATE:
02/03/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Administrator Valdez ShannonTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA), Ketki Desai conducted an unannounced Required 1 year inspection of the above facility on today's date. LPA Ketki Desai toured the facility with the Administrator Valdez Shannon. This is a before and after school program. This facility has a separate preschool & Infant license.(304270334 and 304270335 ). The program is held in school age room across the center lobby.
There were no school age children present at the time of inspection.
A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
Operating hours are 6:30 am- 6.30 PM, and 10.00 PM one Friday of each month Mon-Fri. Children are signed in upon arrival at 6.30 am and are transported by the staff to the school at 8.00 am and later are picked up upon school closure time.
During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios.

THe school age program children have their own play yard and separate gender based restrooms in the classroom. The facility was toured inside and outside and the floor and yard plan were verified. The facility representative stated there is no bodies of water on site. LPA confirmed with facility representative that firearms/weapons are not allowed or stored on premises. The facility appeared clean and orderly
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270336
VISIT DATE: 02/03/2020
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The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises.
PM Snacks & Breakfast are served by the facility and during full day session children are served hot lunch along with snacks. There is drinking water available to children both indoors and outdoors. A current menu is posted in a prominent location viewable by an authorized representative. The facility representative stated menus are dated, kept on file for 30 days and viewable upon request. Food prep areas appear clean and sanitary. Food is properly stored. On site kitchen is free from hazards. Solid waste receptacles have a tight-fitting cover and are in good repair.
The activity items, floors, desks and other equipment appeared clean. The children's bathrooms are clean and sanitary. All materials and surfaces accessible to children are toxic free.

Children do not nap during their time in the facility . The program has conducted an emergency drill on January 28th 2020. The facility has a working smoke detector, carbon monoxide detector, and fire extinguisher.

The playground was completely fenced. The playground equipment appeared in safe condition. There is enough cushioning underneath climbing structures and/or play equipment to absorb falls and has enough shade.
Sign in/out procedure was reviewed for compliance. Children have been signed in and out with legal signatures.

During today's visit staffing ratios were being met. Children's and staff files were in compliance.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270336
VISIT DATE: 02/03/2020
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
Currently there are no children receiving the above Medical services. Medication are stored in a locked cabinet in the kitchen area.

In the areas that were evaluated, deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit.

Provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org
Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182).

During exit interview Report was reviewed and discussed. Appeal Rights was discussed and a copy was provided. The Administrator was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270336
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/03/2020
Section Cited

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CPR:A current pediatric cardiopulmonary resuscitation card issued either by the American Red Cross or the American Heart Association, or by a training program that has been approved by the Emergency Medical Services Authority pursuant to Section 1797.191.
The above evidence is not met by record
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review of one school age teacher who is not current on the required CPR training. This poses a potential risk to H&S to children in care.
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Type B
02/10/2020
Section Cited

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Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion.
The above requirment is not met by evidence of record review of school age teacher
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who is missing the required mandated reporter training certificate in file. This poses a potential risk to Health and safety to children in care,
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2020
LIC809 (FAS) - (06/04)
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