334804330-8-10-2022-10-CC-SHAA-CH6RJB-20220810130342

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334804330
Report Date: 08/10/2022
Date Signed: 08/10/2022 01:03:48 PM

Document Has Been Signed on 08/10/2022 01:03 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 CENTER		FACILITY NUMBER:	334804330
ADMINISTRATOR:	THERESA SALLEY		FACILITY TYPE:	840
ADDRESS:	11961 PERRIS BLVD		TELEPHONE:	(951) 243-6558
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	42	CENSUS: 0	DATE:	08/10/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Theresa Salley		TIME COMPLETED:	01:15 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	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 07/05/2022. LPA met with Theresa Salley (Director) to discuss the incident. A tour of the facility was granted, and census was conducted. On 07/05/2022, it was reported that a child (C1) in the school age classroom contacted his mother via phone and informed her that another child (C2) kicked him in his private area. This information was shared by the parent to Ms. Simone the teacher who was supervising C1 at that time. C1 did not alert the teacher present about the incident. Upon investigation by the school staff it was determined that this incident could not have happened. The time C1 was stating this incident occurred was when Ms. Salley and Ms. Simone were present in the classroom and had observed C1 lying on the floor resting. During that period there were other children on the carpet playing with toys but C2 was not present. Both teachers did not see any altercation occur in the classroom. C1 and C2 are assigned to different classrooms and are not together at any point of the day. If due to any reason the classrooms are joined, C1 or C2 is supervised by another staff member. C1 has been using verbiage like “I am going to get a heart attack” while playing games on the computer and at another time stated to the teacher that he fainted. When the teacher and the Director asked him further questions, he stated that since it is very hot, he feels like he is going to faint. The staff at the facility has spoken to the child about using proper words so that the information is not misinterpreted. See LIC 809C for Continuation

SUPERVISOR'S NAME: Carlos Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

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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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: 08/10/2022

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C2 does not attend the facility anymore and the classroom for C1 has also been reassigned. The Director ensures that there is always extra visual supervision on school age children and additional staff is assigned to assist the classes when needed.

LPA has determined that the facility has taken the necessary steps and is ensuring proper supervision is provided to ensure the health and safety of the children in care.

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 Martinez	TELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya Habeebulla	TELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2022

LIC809 (FAS) - (06/04)

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