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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393602969
Report Date: 07/30/2021
Date Signed: 07/30/2021 01:01:28 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:KINDERCARE LEARNING CENTER - MARINERS (PRESCHOOL)FACILITY NUMBER:
393602969
ADMINISTRATOR:MELINDA GOMEZFACILITY TYPE:
850
ADDRESS:7801 MARINERS DR.TELEPHONE:
(209) 477-3723
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY:64CENSUS: 36DATE:
07/30/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Melinda GomezTIME COMPLETED:
01:20 PM
NARRATIVE
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On Friday, July 30, 2021 at 12:25 p.m._Licensing Program Analyst (LPA) Elvira Sierra met with Program Director, Melinda Gomez for a case management inspection. Upon arrival LPA observed 36 preschool children supervised by 6 staff.

During a recent investigation it was revealed that facility did not report unusual incident to responsible parties immediately after the incident. Unusual Incident occurred on 05/18/21 which involved a staff member handling a child in a rough manner. LPA reminded Director that an unusual incident report shall be made to the Department by telephone or fax within the Department’s next working day and during its normal business hours. In addition, a written report containing the incident information shall be submitted to the Department within seven days following the occurrence of such event. Unusual Incident shall also be reported to the child’s authorized representative immediately after the incident. LPA received Unusual Incident Report on 05/25/21 via email.

See attached page for deficiencies cited against the facility under CCR Title 22, Div. 12, Chapt. 1. This report will be kept in the facility file and will be made available for Public Review upon request. Appeals of Rights were discussed with Director. Notice of Site Visit was provided and shall remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833

FACILITY NAME: KINDERCARE LEARNING CENTER - MARINERS (PRESCHOOL)
FACILITY NUMBER: 393602969
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2021
Section Cited

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101212 (d) Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.
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In addition, a written report containing the information specified in (d)(2) below shall be submitted.......This requirement was not met as evidence by; Facility did not report the incident ocurred on 05/18/21 to the Depatment. LPA requested a completed Incident Report to the Director on 05/25/21. This can pose a health and safety risk to the children in care.
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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: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2021
LIC809 (FAS) - (06/04)
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