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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809073
Report Date: 03/10/2022
Date Signed: 03/10/2022 12:46:37 PM


Document Has Been Signed on 03/10/2022 12:46 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 CENTERFACILITY NUMBER:
364809073
ADMINISTRATOR:SALVADOR-RIVERA, JESSICAFACILITY TYPE:
840
ADDRESS:16149 FOOTHILL BOULEVARDTELEPHONE:
(909) 823-2323
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:27CENSUS: 0DATE:
03/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jessica Salvador-Rivera/DirectorTIME COMPLETED:
01:10 PM
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On 3/10/2022 at 12:00 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a case management incident report regarding an incident that occurred on 2/23/22. LPA was granted access into the facility and met with director. There were no children present during the visit.

It was reported on 2/23/22 C1,picked up C2 and threw C2 to the floor. It was reported staff saw the incident happen, however, was not able to stop it as it was happening. Director stated she did an in house investigation.


Due to further information needed, LPA will return at a later date to conclude the incident.


Exit interview conducted with director, report and appeal rights provided.


Notice of Site Visit issued.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
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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