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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343615335
Report Date: 06/27/2023
Date Signed: 06/27/2023 12:54:48 PM


Document Has Been Signed on 06/27/2023 12:54 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:KINDERCARE LEARNING CENTER - ELK GROVE FLORINFACILITY NUMBER:
343615335
ADMINISTRATOR:CHAVEZ, ANGELAFACILITY TYPE:
830
ADDRESS:9250 ELK GROVE FLORIN ROADTELEPHONE:
(916) 714-2772
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:24CENSUS: 8DATE:
06/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Suzana CervantezTIME COMPLETED:
01:30 PM
NARRATIVE
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On 06/27/2023, Licensing Program Analyst Jennie Tedlos (LPA1) and Licensing Program Analyst Katy Maestas (LPA2) conducted a field visit to the facility for the purpose of a case management inspection to follow up on a self reported Unusual Incident Report (UIR). LPAs arrived at the facility and disclosed the purpose of the inspection and were granted entrance. LPAs met with Suzana Cervantez (AD).

Based on record reviews and LPA observations, the facility is being cited for one Type A deficiency on a subsequent 809-D page. As a result of the deficiencies, AD understands that LIC 9224 must be signed by all current authorized representatives and potential authorized representatives for up to one year. The LIC 9224 must be kept in each child's file for the department's review. Additionally, one Technical Violation was issued as a reminder to follow regulations for staff qualifications.

An exit interview was conducted, and the report was reviewed with AD. LPA provided AD with Licensee Appeal Rights. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 215-3003
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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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Document Has Been Signed on 06/27/2023 12:54 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827


FACILITY NAME: KINDERCARE LEARNING CENTER - ELK GROVE FLORIN
FACILITY NUMBER: 343615335

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2023
Section Cited
CCR
101229(a)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Acting Director (AD) will email LPA by closing 6/28/23 a copy of staff memo instructing all staff members to attend a Zoom staff meeting by July 7, 2023 to discuss children supervision. AD will email LPA a picture of all staff members in attendance by July 7, 2023.
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This requirement was not met as evidenced by: LPA learned that an infant was left alone in an area of the facility without teacher supervision. This poses an immediate risk to the health & safety of children in care.
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HSC

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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: Bettina EngelmanTELEPHONE: (916) 215-3003
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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