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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364804215
Report Date: 05/09/2023
Date Signed: 05/09/2023 11:08:46 AM


Document Has Been Signed on 05/09/2023 11:08 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
364804215
ADMINISTRATOR:ASHLEY MORALESFACILITY TYPE:
840
ADDRESS:10191 FOOTHILL BLVDTELEPHONE:
(909) 989-6136
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:48CENSUS: 0DATE:
05/09/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ashley Morales/directorTIME COMPLETED:
11:31 AM
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On 5/9/23 at 9:00 am, Licensing Program Analyst's (LPA's) Patricia Berry and Claudia Caywood conducted a case management/incident investigation. LPA's were granted access into the facility and met with director. LPA's toured facility and took census. No children present during investigation LPA obtained documentation..


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 4/24/23..

Facility records were reviewed and documentation obtained. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the director.

An exit interview was conducted with director and a copy of this report was provided, appeal rights and notice of site visit.

Notice of Site Visit must be posted for 30 days.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2023
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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