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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270924
Report Date: 06/16/2021
Date Signed: 06/16/2021 12:47:28 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:
304270924
ADMINISTRATOR:SAUNDERS, VALERIEFACILITY TYPE:
830
ADDRESS:855 PASEO WESTPARKTELEPHONE:
(949) 262-0260
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:32CENSUS: 23DATE:
06/16/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Taylor Camarena, directorTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Valencia conducted an on site inspection for the purpose of a Case Management Incident Inspection. The purpose of today's Case Management inspection was in response to an unusual incident reported to the Licensing office, on 6/8/21. The incident detailed an infant, child #1 (see Confidential Names List LIC811) crawling out of an infant room, down the facility hallway and being discovered by a preschool staff at a preschool room.

During the inspection, LPA interviewed 4 staff, all staff involved in the incident. It was determined that child #1 was in Infant Room A with staff #2 and Staff #3 along with 7 other infants. Staff #2 and Staff #3 were putting a child down for nap and tending to bottles, respectively and not properly supervising the infants nor child #1. During that time, child #1 crawled out an open side door into Infant Room B, out the front door of Infant Room B that was open, down the hall approximately 25 feet to an open preschool classroom, where a Staff #4 discovered the child #1 crawling towards them unsupervised. Staff #4 then notified the director, staff #1 who was nearby. Staff #1 then returned the child #1 to Infant Room A. It has been determined that child #1 was not supervised for approximately 3 minutes. Since this incident, Director has met with the staff involved and attempted to determine the cause of the incident and the lapse in supervision. Infants have since been moved into the open Infant Room B where there is better air flow and better temperature control to keep the doors shut. Director also met with the staff involved in the incident and other staff in the center on 6/10/21. Director will be meeting with all the remaining staff who did not participate in the meeting on 6/10 today at 6/16. LPA addressed the severity of this incident and the importance of staff needing to diligently supervise infants, and director understood and agreed. LPA printed, and reviewed the infant Supervision regulations for the director and left them a copy. This presented/presents an immediate threat to the child/ren's health and safety and cited as an A violation. Based on LPA's observations and interviews the following violation are being cited in accordance with California Code of Regulations, Title 22, Division 12, Chapter 3, Section 101429(A)(1) is being cited on the attached LIC 809D.
(continued on LIC809C)
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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 3
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: 304270924
VISIT DATE: 06/16/2021
NARRATIVE
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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. If the facility receives a Type A violation, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00
End of Report.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 304270924
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/16/2021
Section Cited

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Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.
This was not met as evidenced by:

On 6/8/21 it was self reported by the facility that a child #1 crawled out of the infant room A, into an unoccupied Infant room B, down
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a hall to an open preschool classroom where a staff #4 discovered and returned the child. It was determined through interview and review of the incidient that the infant was not supervised for approximately 3 minutes. This presents an immediate threat to the children's and this child #1's health and safety.
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from the meeting, and stated that the facility will do everything they can to supervise all children at all times and maintain the health and safety of the children.

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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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:
DATE: 06/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/16/2021
LIC809 (FAS) - (06/04)
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