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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809073
Report Date: 01/03/2023
Date Signed: 01/03/2023 03:05:41 PM


Document Has Been Signed on 01/03/2023 03:05 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: 38DATE:
01/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Jessica Salvador-RiveraTIME COMPLETED:
03:20 PM
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On 1/3/2023 at 2:27 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a case management incident visit regrading a Unusual Incident that occurred 12/19/2022. LPA met with Jessica Salvador-Rivera and was granted access into the facility. LPA toured facility and took a census.

On 12/19/2022 an incident was reported to Community Care Licensing. The incident did not directly involve the facility. LPA provided resources to the director. At this time there are no violations of Title 22 regulations.


Exit interview conducted with director, report, appeal rights, Notice of Site Visit and resources provided to the director.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023
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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