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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370015
Report Date: 08/14/2019
Date Signed: 08/14/2019 01:09:48 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:
304370015
ADMINISTRATOR:CABASAL, ANDREAFACILITY TYPE:
830
ADDRESS:1000 CORPORATE DRIVETELEPHONE:
(949) 364-0193
CITY:LADERA RANCHSTATE: CAZIP CODE:
92694
CAPACITY:44CENSUS: 17DATE:
08/14/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:DirectorTIME COMPLETED:
10:45 AM
NARRATIVE
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An unannounced Annual Required inspection was conducted today by Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek who met with assistant director, Josie Stephan. LPA met with director, Andrea Cabasal during inspection. Census was taken and there were a total of 17 infants and toddlers with 5 staff in 3 different rooms. There was one staff with 2 awake infants and there was on staff with 3 napping infants in the crib area. There was one staff with four older awake infants in the other infant room. There were 8 toddlers with 2 staff in toddler classroom. There were no children in one of the other toddler classroom.

A review of criminal record clearances indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
The facility was reviewed to ensure compliance with license conditions and limitations, staffing and ratios, inaccessibility to poisons, medication, and hazardous items that can pose a danger to children. Equipment and furniture was inspected to ensure it's in good condition, free of sharp, loose or pointed parts. The bins had tight fitting covers. The napping area is separated from the activity are and has sufficient infant napping equipment. There is no walkers on the premises. The changing table is within the arm's reach of a sink. Bottles and dishes are labeled with the current date and children's names. The infants and toddlers were being supervised in the awake area and the napping area. There are no weapons, firearms or bodies of water in the facility. The playground was inspected for safety, good condition of equipment, including appropriate cushioning material around and under high climbing equipment. Staff's files were reviewed for education verification, CPR/First Aid, infant/toddler units, and new immunization requirements for (MMR, Pertussis, and Flu vaccines). A sample of children's files were reviewed for completeness of medical assessment, and verification of sign in/out including time the child was signed in/out by authorize representative as well as
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SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
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: 304370015
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/28/2019
Section Cited
CCR
101220(a)
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Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health related services to the child. This section was not met as
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The director, Andrea Cabasal stated she would obtain the required forms (Physician's report) from those children's parents. The director agreed to send the copy of the forms to our office by the due date of 8/28/19.
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evidenced by reviewing five children's files today resulting 2 children were missing physician report form on their files. The facility failed to meet this section of regulations. This is a potential risk to the health and safety of children in care.
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Type B
08/28/2019
Section Cited
CCR
101419.2(a)
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Infant Needs and Service Plan-Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the infant. This section was not met as evidenced by reviewing five children's files today resulting 5 children were missing Infant
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The director , Andrea Cabasal stated she would obtain the required forms (Infant Needs and Service Plan) from those children's parents. The director agreed to send the copy of the forms to our office by the due date of 8/28/19.
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Needs and Service Plan forms on their files. The facility failed to meet this section of regulations. This is a potential risk to the health and safety of 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: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 3 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: 304370015
VISIT DATE: 08/14/2019
NARRATIVE
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verification of representatives full legal signature. The facility's individual feeding plan for each infant reviewed and five infants did not have an infant Needs and Services Plan. LPA reviewed storage of medication and equipment /supplies, and reviewed children's, personnel, and administrative records. Some medication for children has been expired in the medicine box. The updated plan of operation for providing IMS services has been received in our office. For IMS information see Evaluator Manual Regulation Interpretations and Procedures for Child Care Centers Sections 101173 Child Care Centers and the ADA, available at http://www.ada.gov/child qanda.htm.
The Notice of Site Visit was posted. Facility representative 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. The licensee was provided a copy of their appeal right (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. The facility representative was informed that they can refer to our Department website at www.ccld.ca.gov for obtaining the quarterly updates. Exit interview was conducted. 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 (LIC 9182).
Also provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

A copy of child care provider's guide to safe sleep pamphlet and a copy of Never Ever Shake a Baby pamphlet with the website www.dontshake.org were given to the facility representative on the previous inspection. An updated pamphlet regarding safe sleep regulations in childcare and a pamphlet for lead poisoning facts were given to the director today.


In the areas that were evaluated, the facility was not in compliance of the California Code of Regulations, Title 22, Division 12. The deficiencies were cited on LIC 809D dated 8/15/2019.
SUPERVISOR'S NAME: Patricia MaganaTELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Mahnaz MalekTELEPHONE: (714) 292-9851
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3