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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603022
Report Date: 05/10/2019
Date Signed: 05/10/2019 09:09:50 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KINDERCARE LEARNING CENTER - VINTAGE PARK (PS)FACILITY NUMBER:
343603022
ADMINISTRATOR:ROMERO, TIAFACILITY TYPE:
850
ADDRESS:8887 VINTAGE PARKTELEPHONE:
(916) 682-1111
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY:72CENSUS: 17DATE:
05/10/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
06:45 AM
MET WITH:Tia RomeroTIME COMPLETED:
09:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility for a Case Management Incident inspection. LPA met with Director, Tia Romero, regarding an Unusual Incident that took place April 12th, 2019. LPA made observations and interviewed staff regarding the incident.

Director stated that they will fill the holes around the play yard and cover the drainage cover so incidents will no longer occur.

In the areas that were evaluated, deficiency was observed at the time of the visit and cited on LIC 809D. An exist interview was conducted and report was reviewed with licensee who stated she understands todays inspection. Notice of Site Visit posted and licensee understands it must remain posted for 30 days.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KINDERCARE LEARNING CENTER - VINTAGE PARK (PS)
FACILITY NUMBER: 343603022
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2019
Section Cited
CCR
101238.2(d)(2)
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Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This is not met be evidence: LPA observed physical plant issues such as a drainage cover and holes in the lawn of the play yard.
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DIrector stated that they will have the holes filled and drainage grate covered by POC date: 6/10/19.
LPA will return to inspect the play yard.
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This is a potential risk to the children in care.
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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: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2019
LIC809 (FAS) - (06/04)
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