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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804324
Report Date: 02/08/2022
Date Signed: 02/08/2022 04:45:44 PM

Document Has Been Signed on 02/08/2022 04:45 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804324
ADMINISTRATOR:MARGARITA D. GUILLERMOFACILITY TYPE:
840
ADDRESS:23301 OLIVEWOOD PLAZA DRIVETELEPHONE:
(951) 924-1956
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 48TOTAL ENROLLED CHILDREN: 29CENSUS: 17DATE:
02/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Farhana Alam - Assistant Director TIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Rachel Zeron and Nasha King arrived at the facility to conduct a case management inspection in response to the receipt of an unusual incident report (UIR). The incident occurred on 01/03/2022, and LPA Zeron was notified of the incident on 01/05/2022. The written incident report (LIC 624) was submitted by the facility on 01/05/2022.

Upon arrival, LPAs were greeted by LPAs informed Farhana Alam, Assistant Director the purpose of the visit and were given authorization to enter the facility. LPAs toured the facility, gathered documentation and conducted interviews. During the inspection. Fahara provided additional information regarding the incident. Later during the visit, Director Jesika Guillermo arrived.

The report documented an incident involving two staff members. They were involved in an verbal altercation that occurred at the facility in front of children and parents. According to the report, S1 made a comment regarding S2's child that currently attends the facility. The situation quickly elevated and both staff began shouting, S1 tried to close the door to end the confrontation , S2 continued to shout down the hall, the confrontation continued between both staff.

Based on the information gathered, there is a violation of Title 22 regulations. A citation was issued in accordance with Personal Rights.

An exit interview was held with Fahara Alam, Assistant Director. A Notice of Site visit was issued, along with a copy of this report.

A copy of this report must be made available to the public, at the facility site, for 3 years.

SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2022
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 02/08/2022 04:45 PM - It Cannot Be Edited


Created By: Rachel Zeron On 02/08/2022 at 06:09 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804324

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)

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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:Stephanie Hudak
LICENSING EVALUATOR NAME:Rachel Zeron
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 02/08/2022 04:45 PM - It Cannot Be Edited


Created By: Rachel Zeron On 02/08/2022 at 03:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804324

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/09/2022
Section Cited
CCR
101223(a)(2)

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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
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Director agreed to conduct training for staff involved regarding personal rights. Training will be conducted by the end of business day 02/09/2022. Staff are to sign the training documents and Director is to send them to LPA for approval.
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Based on LPA confidential interviews:
Staff 1 and staff 2 engaged in a verbal confrontation in front of parents and children.
which poses as an immediate health, safety or personal rights risk to persons 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:Stephanie Hudak
LICENSING EVALUATOR NAME:Rachel Zeron
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2022


LIC809 (FAS) - (06/04)
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