364808909-1-10-2023-09-CC-DBRL-CMY3Y6-20230110173926

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364808909
Report Date: 01/10/2023
Date Signed: 01/10/2023 05:39:38 PM

Document Has Been Signed on 01/10/2023 05:39 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	364808909
ADMINISTRATOR:	BOYCHUK, MILLIE		FACILITY TYPE:	840
ADDRESS:	13523 BASELINE		TELEPHONE:	(909) 463-6598
CITY:	FONTANA	STATE: CA	ZIP CODE:	92336
CAPACITY:	42	CENSUS: 25	DATE:	01/10/2023
TYPE OF VISIT:	Case Management - Lead Testing/Exceedance	UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Millie Boychuk		TIME COMPLETED:	05:45 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Due to required lead testing requirements, Licensing Program Analyst (LPA), Diana Brasel conducted a Case Management inspection based on lead testing results received from the facility. LPA Brasel toured the facility, took census and met with Director to further discuss lead results received and measures taken for remediation of lead exceedances.

During the inspection, LPA toured and obtained photos of the water outlet identified on the sketch and report. Per results 1 drinking fountain exceeded the required specs, the drinking fountain has been replaced, it is awaiting retesting due to delay in initial report being sent to a wrong facility. Per sketch fountain F is located in a Jr School age (kindergarten) classroom that has not been used since 03/2020.

Facility implemented the following plan of action until formal remediation can be completed on water fountain: The fountain has been labeled with a large sign DO NOT USE and the room is not occupied with children. Facility has access to additional drinking fountains that meet specs.

Additionally, the following resources were discussed and provided from PIN 21-21-CCP dated July 28, 2021:

101700.6 Grant Funding for Qualifying Child care Centers

(a) Senate Bill 862, Chapter 449, Statutes of 2018 allocated $5 Million to the State Water Resources Control Board for testing and remediation of lead in the drinking water of Child Care Centers based on the following criteria:

continued on LIC 809C:

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana Brasel	TELEPHONE: 951-205-9491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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: 364808909
	VISIT DATE: 01/10/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(1) Those that serve children zero to five years of age, with the highest priority for Child Care Centers that provide care for children zero to three years of age.

(2) Those that have 50 percent or more of their registered children who receive subsidized care.

(3) Those that operate only one facility.

(b) To determine a Child Care Center’s eligibility for possible funding the Department will provide access to a link to an online eligibility form located on the Department’s website and on Sacramento State’s Office of Water Programs website.

(1) A Child Care Center interested in financial assistance shall complete the eligibility form, which shall include instructions for completing and returning it, prior to receiving any grant funding for which it may qualify. To determine a Child Care Center’s eligibility for possible funding, the provider will need to complete an online eligibility form available at Office of Water Programs’ website

Due to facility water outlet testing above approved lead levels, a deficiency has been cited.

See LIC809D.

An exit interview was conducted, and appeal rights discussed. A copy of this report was provided to the Director, appeal rights and notice of site visit.

This report must be made available to the public upon request for three years.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana Brasel	TELEPHONE: 951-205-9491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 01/10/2023 05:39 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 364808909
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/10/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/10/2023 Section Cited	1 2 3 4 5 6 7	California Lead Action Level at Child Care Centers 101700.3 (b)(1): A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility will implement a plan of action to prevent usage of the drinking fountain until the retested results are at or below the Action level. The facility willl notify CDSS with completion within 30 days.
	8 9 10 11 12 13 14	Based on records review of required lead testing, the facility had lead values of 5.5 or above with 1 drinking fountain in a classroom not being used since 03/2020: This is a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana Brasel	TELEPHONE: 951-205-9491
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3