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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001825
Report Date: 07/15/2021
Date Signed: 07/15/2021 12:14:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001825
ADMINISTRATOR:WENDY CERTEZAFACILITY TYPE:
850
ADDRESS:1101 ROSE DRIVETELEPHONE:
(707) 745-0916
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY:72CENSUS: 30DATE:
07/15/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Erika Ramirez TIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted an unannounced Case Management visit and met with Center Director, Erika Ramirez to deliver this report and citations. During the course of a complaint investigation, Licensing Program Analyst (LPA), Melchisedeck Augustin, obtained evidence showing that due to shortage in staffing, there was a lack of supervision at the facility and staff records were incomplete.

From 04/14/21 through 04/28/21, LPA interviewed one parent, four adults, and seven staff. Seven statements provided by adults and staff reported a lack of supervision at the facility. One adult reported witnessing children left without staff supervision in the facility hallway. The statements further described that on several occasions, a teacher sat between two adjoining preschool classrooms to supervise the children in both classes which had a total of 30 children.

On 04/19/21 and 05/11/21, LPA reviewed eleven staff records which showed that ten staff did not comply with immunization requirements as required by Health and Safety Code (H&SC) 1596.7995(a)(1), and two staff did not have proof of negative TB as mandated by California Code of Regulations (CCR) 101216(g)(1). Staff records reviewed also revealed five out of eleven staff records were missing the AB 1207 Mandated Reporter Training certificate as required by H&SC 1596.8662(b)(1). Furthermore, the facility did not comply with reporting requirements because CD did not submit her verification of Director’s qualification to the Department within 10 days, as required by CCR 101212(b)(1)(A).

Based on interviews and staff records reviewed, there is enough corroborating evidence to show that the facility did not comply with CCR and H&SC. The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Notice of Site Visit shall be posted for 30 days. Appeal Rights were provided. (Continue to LIC 809-C)
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001825
VISIT DATE: 07/15/2021
NARRATIVE
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Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001825
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/16/2021
Section Cited

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The licensee shall provide care and supervision as necessary to meet the children's needs.
This requirement is not met as evidenced by: Based on statements provided by adults and staff which reported a lack of supervision at the facility.
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This poses an immediate health and safety risk to the children in care.
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The written plan will be submit her plan to the Department by 07/16/21.

email: melchisedeck.augustin@dss.ca.gov
public email: cclrpregionalofficegeneral@dss.ca.gov
Fax: 707-588-5099

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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: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001825
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2021
Section Cited

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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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This requirement is not met as evidenced by: Based on eleven staff records reviewed which showed that ten staff did not comply with immunization requirements as required by Health and Safety Code (H&SC) 1596.7995(a)(1). This poses a potential health and safety risk to the children in care.
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email: melchisedeck.augustin@dss.ca.gov
public email: cclrpregionalofficegeneral@dss.ca.gov
Fax: 707-588-5099
Type B
08/29/2021
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she
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completed the initial mandated reporter training.
This requirement is not met as evidenced by: Based on staff records reviewed which revealed five out of eleven staff records were missing the AB 1207 Mandated Reporter Training certificate as required by H&SC 1596.8662(b)(1).
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email: melchisedeck.augustin@dss.ca.gov
public email: cclrpregionalofficegeneral@dss.ca.gov
Fax: 707-588-5099
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: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001825
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2021
Section Cited

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Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
This requirement is not met as evidenced by:
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based on staff records reviewed which reveald that two staff did not have proof of negative TB as mandated by California Code of Regulations (CCR) 101216(g)(1). This poses a potential health and safety risk to the children in care.
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email: melchisedeck.augustin@dss.ca.gov
public email: cclrpregionalofficegeneral@dss.ca.gov
Fax: 707-588-5099
Type B
07/29/2021
Section Cited

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Whenever a change in child care center director is reported, in addition to his/her name, the report shall include the following: Verification of the completion of the course work required in Section 101215.1(h). A photocopy of a college transcript, or a photocopy of a
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Child Development Site Supervisor Permit or a Child Development program Director Permit, shall meet this requirement.
This requirement is not met as evidenced by: based on CD not submitting her verification of Director’s qualification to the Department within 10 days, as required by CCR 101212(b)(1)(A). This posed a potential health and safety risk to the children in care.
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email: melchisedeck.augustin@dss.ca.gov
public email: cclrpregionalofficegeneral@dss.ca.gov
Fax: 707-588-5099
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: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5