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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818107
Report Date: 10/28/2022
Date Signed: 10/28/2022 10:01:16 AM


Document Has Been Signed on 10/28/2022 10:01 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 CENTERFACILITY NUMBER:
364818107
ADMINISTRATOR:EMILY CALHOUNFACILITY TYPE:
850
ADDRESS:33788 YUCAIPA BLVD.TELEPHONE:
(909) 797-4713
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:64CENSUS: 38DATE:
10/28/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Assistant Director, Ruth DeAndaTIME COMPLETED:
10:05 AM
NARRATIVE
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On 10/28/2022, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility for another purpose.
During this inspection, LPA Hogue took census of children present, along with facility associations. LPAs discussed the following with Assistant Director, Ruth DeAnda:

On 10/26/2022, while LPA Hogue toured the facility and conducting classroom observations, LPA Hogue an uncleared and associated adult assisting the Teacher in the Three's Classroom. LPA Hogue observed the aide, setting up classroom mats, serving milk, and passing out blankets and sheets to children in the Three's Classroom. LPA Hogue interviewed staff member(s) and it was disclosed, the adult is a One on One Aide for a child(ren) enrolled in the classroom. LPA Hogue asked Assistant Director for documentation or agreement for the Aide and at the time of the inspection, there was no documentation or agreement form on file. Interviews with facility staff member(s) disclosed that staff are unaware of KinderCare's policy or plan of operation related to outside visitors attending to child(ren) in care. Based on this information, the facility is not following and/or is unaware of KinderCare's plan of operation and/or policies; therefore, this is a violation of Title 22 Regulations.

SEE LIC809-D FOR CITED DEFICIENCIES

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Assistant Director, Ruth DeAnda.

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
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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Document Has Been Signed on 10/28/2022 10:01 AM - It Cannot Be Edited

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: 364818107

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2022
Section Cited

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PLAN OF OPERATION (d) The child care center shall operate in accordance with the terms specified in the plan of operation.




This requirment was not met as evidenced by:
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During facility observations, LPA Hogue observed an One on One Aide assisting a teacher in the Three's Classroom. The Aide was setting up classroom mats, serving milk, and handing out blankets to children in care which poses a potential health, safety, and personal rights risk to children in care.
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Assistant DIrector agrees to place the completed form in the child(ren)'s file. Assistant Director agrees to submit a written plan detailing how the facility will ensure they're following KinderCare's Plan of Operation, specifically for a child(ren) needing an One on One Aide or any other individual services.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
LIC809 (FAS) - (06/04)
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