<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270926
Report Date: 11/17/2021
Date Signed: 11/17/2021 11:43:54 AM

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:
304270926
ADMINISTRATOR:TAYLOR CAMARENAFACILITY TYPE:
850
ADDRESS:855 PASEO WESTPARKTELEPHONE:
(949) 262-0260
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:128CENSUS: 60DATE:
11/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Taylor Camarena, directorTIME COMPLETED:
12:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Dean Valencia conducted an on site inspection for the purpose of a Case Management Incident inspection, in response to an Unusual Incident Report submitted to the Licensing office on 10/19/21. An Unusual Incident Report UIR LIC624 form was submitted to the Licensing office on 10/25/21 detailing that 2 children, child #1 and #2(see Confidential Names List LIC811), were left on the outdoor play area and discovered by a staff #2. During today's inspection, LPA conducted a physical plant inspection, interviewed director and 1 other staff, interviewed an adult #1, made attempts to interview child #1 and #2, and gathered and reviewed documentation related to the incident. In care during the inspection were 60 preschool children, and 10 preschool staff.

It was determined from the information available to LPA during the inspection, that the C1 and C2 were left on the preschool outdoor play area at approximately 1133am to 1135am, by a staff #1. S1 brought 13 children out to the outdoor play area at approximately 11am, erroneously counting 12 children. S1 returned to the classroom 4A leaving C1 and C2 outside. An adult #1 arrived and a staff #2 went to room 4A to retrieve the C1 at approximately 1140am. At this time it was discovered that C1 was not in the class. S2 went outside to the play area and discovered C1 and C2 unsupervised. C1 and C2 were promptly returned to their classroom 4A. Children were determined to be left unsupervised outside for approximately 5 to 7 minutes. LPA has determined from the information gathered that facility violated Title 22 Regulations regarding Supervision and Ratio, 101229(a)(1), 101216.3(a) respectively. A printout of Title 22 Regulations of Supervision and Ratio was reviewed and provided for the director. In response to this incident, director spoke with every staff in person on 10/20/21, staff #1 is not longer working at the facility, and director is planning to conduct a staff meeting on 11/24/21 to address this incident. All of this information and corrections in response to the violations cited and incident, will be submitted to LPA promptly. Based on information LPA gathered during today's inspection, the following violation(s) was determined to have occurred, and is being cited in accordance with Regulations Title 22 Sections 101229(a)(1) and 101216.3(a) 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: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
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: 304270926
VISIT DATE: 11/17/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(page 2)
Appeal Rights and deficiencies were discussed with the director. 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 given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director. 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
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Dean ValenciaTELEPHONE: (714) 215-6737
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
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: 304270926
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/17/2021
Section Cited

1
2
3
4
5
6
7
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This was not met as evidenced by:

Based on LPA's interviews it was
8
9
10
11
12
13
14
determined that on 10/19/21 a Staff #1 left a child #1 and child #2 on the outdoor play area for approximately 5 to 7 minutes. This has been determined to be an immediate threat to the chidren's health, safety, and personal rights.
8
9
10
11
12
13
14
be provided to LPA today on 11/17/21.
Type A
11/17/2021
Section Cited

1
2
3
4
5
6
7
There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance
This was not met as evidenced by:

Based on LPA's interviews it was determined that on 10/19/21 a staff #1 took 13 preschool children to the outdoor play area, for
8
9
10
11
12
13
14
30 minutes. This has been determined to be an immediate threat to the chidren's health, safety, and personal rights.
8
9
10
11
12
13
14
be provided to LPA today on 11/17/21.
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: 11/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3