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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804330
Report Date: 12/03/2021
Date Signed: 12/03/2021 04:43:49 PM

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:
334804330
ADMINISTRATOR:THERESA SALLEYFACILITY TYPE:
840
ADDRESS:11961 PERRIS BLVDTELEPHONE:
(951) 243-6558
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:42CENSUS: 0DATE:
12/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Director, Theresa SalleyTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst's (LPA's) Linda Almaraz, Summaya Habeebulla and Ana Noble conducted an annual inspection as part of a compliance review. This is a combination center and the other licensed programs are: infants and preschool. The preschool program was also inspected on this date. A tour of the inside and outside of the facility was granted and the following was observed and/or noted:

· The following were posted and are updated where necessary:
- License
- Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Menu
· The facility is operating with the limits as stated on the license
· Ratios are being met during this inspection
· Classrooms are adequately equipped with age and size appropriate furniture and equipment and free of hazards
· There are no weapons present at the facility as stated by Theresa Salley
· There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Drinking water is provided in the indoor activity space by water jugs- and in the outdoor activity space by pitchers and disposable cups
· Medications are stored where inaccessible to children,

(Continued on LIC809C)
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M AlmarazTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804330
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above.During the inspection walk-through LPA's and Director observed Bathrooms #1 and 2 dirty. Bathroom #1 had a smelled which was strong like urine upon opening the door, the Director also confirmed the smell. Washing sinks and floors were stained with what appeared to be dust and dirt which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 01/03/2022
Plan of Correction
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The Director agress to have a company come to deep clean the facility and will create a log for the daily cleaning (including restrooms). Director shall submit a copy of the work order and log created by POC due date. Once the deep cleaning is completed LPA will conduct a POC visit.
Ms.Theresa stated the center has a cleaning log and will povide the log for November 2021 via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M AlmarazTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804330
VISIT DATE: 12/03/2021
NARRATIVE
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· Hazardous items are stored where inaccessible to children which include: Disinfectants, cleaning solutions and other items that are dangerous
· Poisons and toxins are locked
· Playgrounds are enclosed by appropriate fencing and free of hazards
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· Food preparation area is clean, free of litter and rubbish and free of rodents and other vermin
· Food is stored appropriately and protected from contamination
· Sign in/Sign out record was reviewed and meets regulation requirements
· Disaster drills are conducted at least every six months – last drill conducted on 11/02/2021.

A review of staff and children's records were conducted as part of this evaluation.
· Children’s records were found to be complete during this inspection.
· A Staff member is present with current Pediatric CPR/First Aid which expires on 7/2022
· Opening and closing staff member’s CPR/First Aid expires on 7/2022.

· Director completed Health and Safety Training
· A review of staff records indicates that all staff present meet minimum qualifications for the position for which they were hired.
· A review of staff records on 12/3/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Currently there are no children receiving Incidental Medical Services, however the facility does offer the service. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

(Continued on LIC809C)

SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M AlmarazTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804330
VISIT DATE: 12/03/2021
NARRATIVE
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The following items were discussed with the Licensee/Director during inspection:
· Menus shall be posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall
· The Licensee was informed of their reporting requirements and provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO10@dss.ca.gov
· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations858@dss.ca.gov

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

On-line Licensing forms & regulations for a Child Care Center can be obtained on the Department’s website: www.ccld.ca.gov. Additionally, there is a link to “Receive Important Updates” located on the right side of the page, immediately above Quick Links. One can add their email address and choose which program(s) they wish to receive Provider Information Notices (PIN) for.



The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:
1-844-LET-US-NO (1-844-538-8766) and/or 951-782-4200

The licensee/director is asked to update the following documents, if applicable, and submit to licensing within 30 days:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made or file copy is more than 2 years old)

(Continued on LIC 809C)
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M AlmarazTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804330
VISIT DATE: 12/03/2021
NARRATIVE
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4.LIC 309 Administrative Organization (only if changes have been made or file copy is more than 2 years old)
5. LIC 308 Designation of Administrative Responsibility (only if changes have been made& current designation is on file)

See LIC809-D for cited deficiencies.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

An exit interview was conducted, and this report was reviewed with Director Theresa. Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 805-5739
LICENSING EVALUATOR NAME: Linda M AlmarazTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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