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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809073
Report Date: 11/04/2021
Date Signed: 11/04/2021 01:03:12 PM

Document Has Been Signed on 11/04/2021 01:03 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:MORALES, ASHLEYFACILITY TYPE:
840
ADDRESS:16149 FOOTHILL BOULEVARDTELEPHONE:
(909) 823-2323
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: 0DATE:
11/04/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Jessica Salvador-Rivera/directorTIME COMPLETED:
01:20 PM
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On 11/4 at 12:20 PM, Licensing Program Analyst (LPA) Patricia Berry conducted a case management incident investigation regarding a Unusual Incident Report, self-reported by director to Community Care Licensing on 10/25/2021. LPA toured facility; however, there were no school-age children present during the visit. Director stated on 10/25 a parent informed her a few months back her child was assaulted by the child's peers. Director stated the child disenrolled on 10/1/21. Director stated, parent stated her child informed her of the incidents that took place, recently.


LPA will need to conduct further investigation and will return at a later date to deliver final report.



Exit interview conducted with director, report, Notice of Sit Visit and Appeal Right provided to the director.


LPA observed director post Notice of Site Visit.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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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