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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818107
Report Date: 11/07/2019
Date Signed: 12/13/2019 07:31:24 AM

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:
364818107
ADMINISTRATOR:TRACY BIERMANFACILITY TYPE:
850
ADDRESS:33788 YUCAIPA BLVD.TELEPHONE:
(909) 797-4713
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:64CENSUS: 36DATE:
11/07/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Tracy Bierman and Ruth DeAndaTIME COMPLETED:
02:15 PM
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On 11/07/2019 at 8:32am, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct a case management inspection in response to the receipt of an unusual incident report (UIR). The UIR was received by the Riverside Child Care Regional Office on 10/07/2019 via fax. The UIR explains a child in the preschool program, fell while playing outside and bruised their nose. The following was discussed during this inspection:

On October 4, 2019, during outdoor play time a child fell off the play structure causing bruising to the child’s nose. LPA interviewed the children involved and received conflicting information on whether or not the child was pushed by another child. According to the teacher who witnessed the incident, the child was walking down the stairway of the playground, tripped and fell on the cushioned outside flooring. A child told a teacher that another child pushed them down the stairs, however staff interviewed stated the child in question was on the other side of the playground and no where near the child when they fell off the play structure. The child did not break their nose and saw a doctor after the incident.

Based on the information obtained during this inspection, there appears to be no violations of Title 22 Regulations at this time.

No deficiencies were cited during this inspection and a copy of this report was provided to Director Tracy Bierman. Director understands a copy of this report shall be kept on record for three years and provided to the public upon request.

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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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