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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334809082
Report Date: 06/08/2023
Date Signed: 06/08/2023 02:08:07 PM


Document Has Been Signed on 06/08/2023 02:08 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:
334809082
ADMINISTRATOR:TARA MARTINEZFACILITY TYPE:
840
ADDRESS:610 E. NUEVO ROADTELEPHONE:
(951) 943-6476
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:28CENSUS: 1DATE:
06/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Taryn Martinez TIME COMPLETED:
02:27 PM
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On June 8, 2023, at 9:01 AM, Licensing Program Analyst’s (LPA’s), Anastasia Flores & Jessica Rubio arrived for the purpose of conducting an annual inspection as part of a compliance review. This is a combination center and the other licensed programs are: Infant and Preschool program, which were “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 Tara Martinez
· 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.
· Filtered supply of drinking water in the indoor activity space (water containers are filled up daily)
· Medications are stored where inaccessible to children,(stored in the kitchen area in a locked cabinet)
· Hazardous items are stored where inaccessible to children which include: Disinfectants, cleaning solutions and other items that are dangerous (there was a bleach bottle and cleanser spray under the sink see Deficiency page)
· Poisons and toxins are locked
· All floors are clean and safe
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
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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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: 334809082
VISIT DATE: 06/08/2023
NARRATIVE
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·Bathrooms were observed to be safe, sanitary and in operating condition
· 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, 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 to be conducted every six months – last drill conducted on 03/09/23

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 06/03/23
· Opening and closing staff member’s CPR/First Aid expires on 06/03/23
· 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 06/08/23, indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

- 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

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.
· Uncontaminated drinking water shall be readily available both indoors and outdoors
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
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: 334809082
VISIT DATE: 06/08/2023
NARRATIVE
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·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

- Licensee [or facility representative] 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.

-To access on-line Licensing forms & Regulations for a Child Care Center please visit: www.ccld.ca.gov. Also, go to the licensing webpage and click on the “Receive Important Updates” located on the right side of the page, immediately above the 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)
4. LIC 309 Administrative Organization (only if changes have been made)
5. LIC 308 Designation of Administrative Responsibility (only if changes have been made)

See LIC809-D for cited deficiencies
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: 334809082
VISIT DATE: 06/08/2023
NARRATIVE
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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.

Exit interview conducted, a copy of this report, LIC809D and appeal rights was reviewed and handed to Director, Tara Martinez o 6/0823. A copy of the LIC 857 (Children’s Record Review), LIC 859 (Staff Record Review), were also provide.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 06/08/2023 02:08 PM - It Cannot Be Edited

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: 334809082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(g)
Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation, the licensee did not comply with the section cited above in the unlocked cabinet below the water faucet had bleach and cleanser spray. This posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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LPA Rubio removed and placed in top cabinet. cleared at time of inspection.
Type B
Section Cited
CCR
101221(b)
Child's Records
(b) Each record shall contain information including, but not limited to, the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in child #5 did not have a file at time of inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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Licensee/Director will provide proof of enrollment for Child #5 by 6/15/23 to LPA Flores via email by 6/15/23. Director stated the child's file must be outside in the classroom due to child being a drop in.
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: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 06/08/2023 02:08 PM - It Cannot Be Edited

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: 334809082

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(8)(B)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information: (B) Instructions for action to be taken in case the child's authorized representative, or the
physician designated by the authorized representative, cannot be reached in an
emergency.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in child #5 did not have file at time of inspection, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/08/2023
Plan of Correction
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Licensee/Director will provide evidence of records for child #5 to LPA Flores via email by 6/15/23. Director stated the child's file must be outside in the classroom due to child being a drop in.
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status as specified in Section 101220, and the following health information: (C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in child child #5 did not have file at time of which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/15/2023
Plan of Correction
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Licensee/Director will provide evidence of records for child #5 to LPA Flores via email by 6/15/23. Director stated the child's file must be outside in the classroom due to child being a drop in. Director handed LPA Flores child's file at time of exit interview.
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: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
LIC809 (FAS) - (06/04)
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