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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364804286
Report Date: 03/13/2024
Date Signed: 04/18/2024 02:54:01 PM


Document Has Been Signed on 04/18/2024 02:54 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/11/2024 08:32 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

NARRATIVE
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This report has been amended, Licensing Program Analyst (LPA) Steven Montoya met Assistant Director Kia McCullough for the purpose of Case Management Deficiency, while following up on a Complaint investigation dated 2-8-2024. Present during today’s visit were 50 children in care and ratios were within title 22 guidelines. LPA toured of the facility and no deficiencies were observed.

LPA discussed the purpose of the interviews with Assist Director. Based on the information obtained: Timeline of incident, facility records and Director admission (interview 2-9-2024). It was determined that the facility has not complied with reporting requirements to the RO which is valid, and the preponderance of evidence has been met. Therefore, the above allegation are Substantiated.

LPA informed Assistant Director that this report is a Type B citation, which shall be posted for 30 consecutive days as there is a potential risk(s) to the health, safety, or personal rights of children in care.

LPA informed the Assistant Director to provide a copy of this licensing report dated 3-13-2024 that documents any Type B citation(s) to parents of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. The Notice of Site Visit was provided, Director was advised it must remain posted for 30 days. A copy of the inspection report and notice of site visit was provided.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Steven MontoyaTELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
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 04/24/2024 10:15 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/11/2024 08:35 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364804286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/18/2024
Section Cited
CCR
101212(d)(1)

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101212 (d) (1) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a
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Director will review reporting requirement regulations and develop a plan for future actions. Send LPA a written plan via email to maintain requirements steven.montoya@dss.ca.gov.
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written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Director did not meet this requirement. This requirement was not met, which is a Type B violation.
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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: Steven MontoyaTELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
LIC809 (FAS) - (06/04)
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