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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270788
Report Date: 07/10/2023
Date Signed: 07/10/2023 04:37:18 PM


Document Has Been Signed on 07/10/2023 04:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
304270788
ADMINISTRATOR:SHOBE, HOLLYFACILITY TYPE:
830
ADDRESS:5396 WALNUT AVETELEPHONE:
(949) 551-6808
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:28CENSUS: 19DATE:
07/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:54 PM
MET WITH:Holly ShobeTIME COMPLETED:
05:00 PM
NARRATIVE
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On July 10 of 2023, Licensing Program Analysts (LPA) A. Silva conducted a Case Management due to deficiencies observed during today's visit. Upon arrival, total census was 19 clients under 24 months of age (7 in the infant room and 12 in the toddler room). The facility was operating within its licensed capacity and within compliance of staff to child ratios. Facility hours are 6 a.m.- 6:30 p.m., Monday through Friday. An on-site Facility Personnel Report Summary review showed that all facility staff or other individuals who require background checks have received criminal record and child abuse index clearances or exemptions.

At approximately 10:30 am staff 1 disclosed to the LPA that S2 had fed breast milk to the wrong infant. The LPA interviewed Director Holly Shobe about the incident. The director stated that the incident had in fact happened, but it was not reported to licensing. The LPA interviewed S3. S3 stated that S2 had taken the wrong bottle and failed to observe the “face-to-name check” protocol to ensure the correct infant received the correct bottle. The director further stated that S2 had been removed from the infant center because S2 was not the right fit. The director stated the incident happened on 5/18/23.

Based on LPAs observations an interview conducted with the staff, the facility is being cited in accordance with California Code of Regulations, Title 22, Division 12, for the following sections: 101427 Infant Care Food Service (see 809D)

Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was provided and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Holly Shobe.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/10/2023 04:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270788

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2023
Section Cited
CCR
101427(g)

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101427 Infant Care Food Service (g)... Bottles and nipples used by one infant shall not be shared with or used by another infant unless sterilized.
The requirement was not met as evidenced by:
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The director stated S2 was removed from the infant center. The director stated she will hold a training about the face-to-name check protocol within the due date and provide proof to the LPA via email.
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Based on interviews, the licensee did not comply with the above regulation in 1 out of 10 infants enrolled, which poses a potential risk to the health, safety, or personal rights of clients in care. The director and S3 stated the incident happened and had been corrected.
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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: Archibaldo SilvaTELEPHONE: (510) 504-4954
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2023
LIC809 (FAS) - (06/04)
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