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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809073
Report Date: 03/25/2022
Date Signed: 03/25/2022 04:15:06 PM


Document Has Been Signed on 03/25/2022 04:15 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: 14DATE:
03/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:17 PM
MET WITH:Aubrey Diehl/Assistant DirectorTIME COMPLETED:
04:30 PM
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On 3/25/2002 at 3:17 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent case management incident investigation. LPA was granted access into the facility and met with Aubrey Diehl/Assistant Director (AD). LPA toured facility and took a census.

It was reported on 2/23/22 C1, picked up C2 and threw C2 to the floor. LPA Berry interviewed staff, child, and parent. Staff stated on 2/23, C1 and C2 were playing on opposite sides of the classroom. Staff stated C2 was playing with some friends and C1 came over and picked up C2 and threw C2 to the ground. Staff stated she was on the other side of the classroom with another child when she heard a thump and observed C1 standing over C2. Staff stated she immediately applied ice to C2’s head and called C2's parents. Staff stated C1 and C2 play together and this incident was a shock to everyone. During child (C2) interview it was revealed C2 was playing with another friend and C1 came from behind and picked up C2 and threw C2 to the floor. C2 stated there was no fighting or arguing prior to the incident. Parent stated she was shocked by the incident but does not blame the facility. Parent stated the facility did everything they could, and would not have predicted this incident prior to it happening.


Based on information obtained there does not appear to be a Title 22 violation at this time. It appears there was proper supervision in the classroom.


Exit interview conducted with Assistant Director, report and appeal rights provided.


Notice of Site Visit issued. 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: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2022
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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