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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804330
Report Date: 05/11/2022
Date Signed: 05/11/2022 01:58:22 PM


Document Has Been Signed on 05/11/2022 01:58 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:
334804330
ADMINISTRATOR:THERESA SALLEYFACILITY TYPE:
840
ADDRESS:11961 PERRIS BLVDTELEPHONE:
(951) 243-6558
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:42CENSUS: 22DATE:
05/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Theresa SalleyTIME COMPLETED:
02:15 PM
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On the date and time listed, Licensing Program Analysts (LPA) Sumayya Habeebulla arrived at the facility to conduct a Case management incident follow-up visit on an Unusual Incident Report (UIR) received by the Department on 05/04/2022. LPA met with Theresa Salley (Director) to discuss the incident. A tour of the facility was granted, and census was conducted.

On 05/04/2022, it was reported that a child in the school age classroom complained about “his heart hurting” while he and his friends were playing soccer. The teacher Ms. Ochoa made the child sit and rest for a while and notified the front office. When the parent arrived to pick the child up, the child complained to the parent stating his friend tried to strangle/choke him. As a result, an investigation was conducted by the facility. The staff member was provided with additional training for care and supervision and the school age children were also provided an informative session on how to play outside.

LPA has determined that the facility took the necessary steps to ensure the health and safety of the children in care by providing the staff member from the classroom with additional training for Care and supervision and reporting the incident to the Department (Community Care Licensing).

Based on the information gathered, there appears to be no violations of Title 22 Regulations found at this time, and therefore, there were no deficiencies cited during this inspection.

An exit interview was conducted, and a copy of this report was provided to Theresa Salley (Director). A Notice of Site Visit was issued, and the Licensee understands that it must remain posted for 30 days.

SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya HabeebullaTELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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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