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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364804215
Report Date: 12/09/2020
Date Signed: 12/09/2020 10:12:14 AM

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:
364804215
ADMINISTRATOR:GASKIN, MELINDAFACILITY TYPE:
840
ADDRESS:10191 FOOTHILL BLVDTELEPHONE:
(909) 989-6136
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:48CENSUS: 41DATE:
12/09/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Melinda Gaskin/DirectorTIME COMPLETED:
10:20 AM
NARRATIVE
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On 12/09/2020 at 9:48 AM, Licensing Program Analyst (LPA) Patricia Berry conducted a tele-inspection visit, via Face Time, due to COVID-19 and DPH guidelines of social distancing. The purpose of the tele-inspection visit was to conduct a case management- incident investigation. LPA made contact with the director, toured facility and took a census. LPA Berry received a unusual incident report on 12/3, regarding child left outside at back door, unattended. Director stated on 12/3, child's teacher was walking her class to her classroom. When teacher arrived at her classroom she was taking a name to face and another staff member brought child to the teacher. Director stated another staff member who was going to her car noticed child was outside at back door, unattended.

According to the director, the child thought it was funny to hide from his teacher. Director reported the incident immediately after incident occurred to Community Care Licensing and took immediate action by investigating the incident. 101229 (a) states, 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, ... Supervision shall include visual observation.

A deficiency is cited on 809D. Due to absence of supervision a civil penalty is issued in the amount of $500.00 and assessed today.

LPA contacted the Director to review the report. This report will be sent via email to the provided email address with an attached read receipt. A copy of the LIC 9213- Notice of Site Visit, LIC 9058- Appeal Rights, LIC 9224- Acknowledgment of Receipt and LIC 421 IM- Civil Penalty will be sent via email along with the report. The read receipt will be used in lieu of the signature on the report.
All reports shall be maintained for three years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020
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: 364804215
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/11/2020
Section Cited

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101229 (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, ... Supervision shall include visual observation.
This requirement was not meet as evidenced by
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Based on unusual incident reported, child was left unattended outside at back door, which poses an immediate risk to the health and safety of children in care. Plan of correction discussed with director. A $500.00 civil penalty issued today.
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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: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2020
LIC809 (FAS) - (06/04)
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