364812756-10-27-2022-09-CC-PBEY-CKLMCK-20221027092940

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364812756
Report Date: 10/27/2022
Date Signed: 10/27/2022 09:29:49 AM

Document Has Been Signed on 10/27/2022 09:29 AM - 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:	364812756
ADMINISTRATOR:	ASHLEY RAWLS		FACILITY TYPE:	830
ADDRESS:	11249 BASELINE AVENUE		TELEPHONE:	(909) 581-0944
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91730
CAPACITY:	40	CENSUS: 12	DATE:	10/27/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ashley Rawls/director		TIME COMPLETED:	10:13 AM

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On 10/27/2022 at 9:00 am, Licensing Program Analyst (LPA) Patricia Berry conducted a case management incident investigation. LPA met with director, toured facility and took a census.

On 10/14/2022 Riverside Regional Office received an Unusual Incident Report (UIR) from the facility. The UIR was self reported from director. Director reported on 10/14 a child who is allergic to eggs was served eggs. Director stated it is noted on child’s emergency consent form and Needs and Service Plan, the child can eat eggs, however, if cooked at 350 degrees and mixed with something it would be safe for the child to eat eggs. Director stated that morning child was served eggs at 350 degrees however the child’s eggs were not mixed with something. Director stated the teacher is a seasoned teacher and knows this child is allergic to eggs. Director stated the teacher was so busy handling the meals for all the children she forgot to mix the eggs with something, and the child had a slight allergic reaction to the eggs. Director stated she was in contact with the parents throughout the day letting them know what was happening with the child. Director stated the child had such a mild reaction the parent felt maybe the child is growing out of the allergy. Director stated the child does not use an EPI pen for this allergy. Director stated going forward the she has implemented mats that go underneath the food plates that indicate whether each child has an allergy and the mat has child’s picture on it and any allergy that they are allergic to. Director stated the teacher was aware after she had served the eggs to the child that she did not follow the proper procedure. Director stated all staff will have a refresher training on children with allergies.

(Cont on 809C)

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia Berry	TELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

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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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: 364812756
	VISIT DATE: 10/27/2022

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Director handled the situation promptly, notified the parents throughout the day, has implemented another procedure to ensure continued safety, and has re-trained her staff on allergy procedures. LPA has determined at this time a Technical Violation will be issued.

Exit interview conducted with director, report, appeal rights, notice of site visit and LIC 9102 Advisory Note-Technical Violation has been provided.

Notice of Site Visit must be posted for 30 days.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia Berry	TELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022

LIC809 (FAS) - (06/04)

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