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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804332
Report Date: 11/03/2021
Date Signed: 11/03/2021 02:12:40 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804332
ADMINISTRATOR:RUBALCABA,BRANDIEFACILITY TYPE:
850
ADDRESS:5445 CANYON CRESTTELEPHONE:
(951) 683-1626
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:96CENSUS: 43DATE:
11/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Brandie RubalcabaTIME COMPLETED:
02:30 PM
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On 11/03/2021 at 8:15 AM Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct a 1 year required annual inspection. LPA was granted entry by Director Brandy Rubalcaba LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following: Normal days and hours of operation are: Monday- Friday, 6:30AM -6:30PM A review of the staff records and children's records were conducted as part of this evaluation.

The inspection consisted of reviews of the following domains:


Food Service
Reporting Requirements
Physical Plant
Care and Supervision
Children Records
Staff Records
Staffing Ratio and Capacity
Personal Rights
The inspection found the facility to be in compliance in these domains, except as noted on the LIC809-D

Documentation of fire & earthquake drills to be conducted every six months: Last drill: 05/2021 See 809D for cited deficiency.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804332
VISIT DATE: 11/03/2021
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The licensee 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)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility
The following items have been 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 within the terms of the license: Yes
· Ratios were met during this inspection: LPA observed 6 staff and 43 children.
· Appropriate supervision was provided during this inspection: Yes
· Classrooms are equipped with age appropriate furniture and equipment in good condition
· Classrooms are clean and free of hazards: yes
· No weapons stored at the facility: Yes
· 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.
· Medications are stored where inaccessible to children: Located in lock box
· Hazards are stored where inaccessible to children which include: Disinfectants, cleaning solutions and other items that are dangerous: Located in locked cabinets
· All floors shall be clean and safe See LIC9102 technical advisory
· Bathrooms were observed to be safe, sanitary and in operating condition: Yes
· Playgrounds are enclosed by appropriate fences and free of hazards: yes
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition. See LIC9102 technical advisory
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804332
VISIT DATE: 11/03/2021
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· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin. Facility has Terminex for pest control maintenance.
· Measures are taken to keep the facility free of flies, other insects and rodents
· Food is stored appropriately and protected from contamination: yes
· All storage containers for solid waste, including moveable bins- have tight-fitting covers and in good repair
· 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: Yes
· Uncontaminated drinking water shall be readily available both indoors and out and provided by Public water supply
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: Facility has rubber foam.
· Sign in/Sign out record was reviewed and meets regulation requirements. See LIC9102 technical advisory
· A Staff member is present with current Pediatric CPR/First Aid which expires on 10/22
· Opening and closing staff member’s CPR/First Aid expires on 10/22
· Director completed Health and Safety Training on 03/19/2016
· Staff qualifications were reviewed – health screening is on file and all staff meet educational requirements and health requirements for performing assigned tasks: Yes
· Staff have received on the job training for house keeping, sanitation and universal health precautions
Licensee was informed of the Department has inspection authority per Health and Safety Codes sections: 1596.852, 1596.853 and 1596.8535.
Licensee was informed of Unusual Incident Reporting email UnusualIncidentReportsDO09@dss.ca.gov
· Required records for children shall ensure that each child’s record contain a medical assessment and contain the Identification and Emergency Information
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804332
VISIT DATE: 11/03/2021
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· AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 –
The bill requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test.
· AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021
· AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 For CCCs: Incidental Medical Services (IMS) policy was discussed

Director Brandie Rubalcaba was reminded that all adults 18 and over living or working in the facility , 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 licensed 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.

LPA discussed the safe sleep regulations with Director Brandie Rubalcaba and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director Brandie Rubalcaba of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804332
VISIT DATE: 11/03/2021
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CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director Brandie Rubalcaba.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC809 (FAS) - (06/04)
Page: 5 of 10
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804332
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA record review, the licensee did not comply with the section cited above with last fire drill on 05/2021 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/03/2021
Plan of Correction
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Licensee will complete a fire drill during today's visit and document on fire drill log. LPA observed drill from start to finish during visit. Licensee will submit proof of completion for next fire drill (March 22) to LPA Carbullido.
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: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/03/2021
LIC809 (FAS) - (06/04)
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