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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334809081
Report Date: 09/13/2023
Date Signed: 09/13/2023 11:30:07 AM


Document Has Been Signed on 09/13/2023 11:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334809081
ADMINISTRATOR:TARA MARTINEZFACILITY TYPE:
850
ADDRESS:610 E. NUEVO ROADTELEPHONE:
(951) 943-6476
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:92CENSUS: 63DATE:
09/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Tara MartinezTIME COMPLETED:
11:40 AM
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At 11:00AM on September 13, 2023, a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 08/14/2023.

It indicates that on 08/11/23, child #1 was involved in an incident where two children were sitting at the top of the slide wanting to slide down. The teacher advised the children that they both could not slide down at the same time and instructed one of them to get up and they could go next. C1 was beginning to get up, and child #2 (C2) pushed C1 over the edge of the slide. C1 landed on the wood chips below. Immediately teacher observed C1 and brought child to the front office, where they assessed C1 and concluded that C1's arm appeared to be broken. Director contacted 911 and C1's parent, who both promptly responded to the facility. Parent and C1 were transported to the hospital and a cast was placed on C1's arm. C1 returned to the day care the next operation day with activity restrictions, which the facility has been in compliance with by providing C1 with alterative activities.

LPA received copies of all relevant paperwork. Based on information gathered, the facility acted appropriately and no violations have been identified.

An exit interview was conducted and a copy of this report was provided to Director Tara Martinez.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
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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