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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270924
Report Date: 10/25/2022
Date Signed: 10/25/2022 12:19:45 PM


Document Has Been Signed on 10/25/2022 12:19 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
304270924
ADMINISTRATOR:STEPHANIE STRANDFACILITY TYPE:
830
ADDRESS:855 PASEO WESTPARKTELEPHONE:
(949) 262-0260
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:32CENSUS: 26DATE:
10/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Stephanie Strand - DirectorTIME COMPLETED:
12:30 PM
NARRATIVE
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An unannounced case management inspection was conducted on this date by Licensing Program Analyst (LPA) Carmen Odom in response to a self-reported incident dated 10/04/22. Present during today’s inspection was the Director, Stephanie Strand. Census was taken in individual classrooms. The overall census observed was 26 infants and 7 infant staff members.

A review of adult records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 10/04/2022 an Unusual Incident Report was filed with the Department to self-report an incident that occurred on 10/03/2022. Assistant director called to inform that they had given Child #1 (C1) the incorrect milk bottle during feeding time at 12:40pm.

At 12:40pm when the incident occurred, staff #1 (S1) was giving staff #2 (S2) a lunch break. C1 was fussy and it was C1’s feeding time, S1 attempted to feed C1 with their bottle but C1 did not want to drink the bottle, S1 placed C1’s bottle on the counter while S1 was soothing C1. About 5 minutes later S1 attempted to feed C1 again, S1 goes to the counter and grabs Child #2 (C2) bottle without noticing that it was the incorrect bottle. S1 gives C1 the bottle with the white label for formula milk on the bottle. Shortly after arrives S2 and informs S1 that they are giving C1 the incorrect bottle. S1 looks at the bottle and observed that they had given C1 the incorrect bottle, in which, it was C2’s bottle with a red label for breast milk. Staff #3 (S3) disclosed they did not observe that S1 was giving C1 the incorrect bottle until S2 arrived. S3 disclosed C1 drank most of the 4-ounce bottle. Director stated parents were notified immediately.

During today's inspection LPA interviewed 4 staff members and conducted a physical plant inspection. Based on the information gathered from the interviews conducted, statements from staff and a physical plant inspection. It was determined that C1 was given the incorrect milk bottle during feeding time for a few minutes, in which, C1 drank 1 to 3 ounces of formula milk. Continue to page 2.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
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: 10/25/2022
NARRATIVE
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California Code of Regulations, Title 22, Division 12, Chapter 1, Section 101427(g)- Infant Care Food Service is being cited on the attached LIC 809D.

This report cites Type A violation and shall be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

Exit interview was conducted with Director, Stephanie Strand. Notice of Site Visit was posted during the inspection. Facility representatives 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. Facility representatives was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/25/2022 12:19 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
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: 10/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2022
Section Cited

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101427(g) Infant Care Food Service
(g) A supply of bottles and nipples shall be maintained at the infant care center. Bottles and nipples used by one infant shall not be shared with or used by another infant unless sterilized. This requirement was not met as evidenced by:
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Based on interviewed and self-reported unusual incident report, C1 was given the incorrect milk bottle during feeding time for a few minutes, in which, C1 drank 1 to 3 ounces of formula milk. This poses and immediate health and safety risk 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: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Carmen OdomTELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3