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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001825
Report Date: 08/04/2023
Date Signed: 08/04/2023 12:41:27 PM


Document Has Been Signed on 08/04/2023 12:41 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001825
ADMINISTRATOR:ERIKA RAMIREZFACILITY TYPE:
850
ADDRESS:1101 ROSE DRIVETELEPHONE:
(707) 745-0916
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY:72CENSUS: 36DATE:
08/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Erika SilvaTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Selena Mariani conducted an unannounced case management inspection and met with Director (D1) Erika Silva. On 5/17/2023, facility self-reported an incident which occurred on 05/15/2023 in which Child 1 (C1) was unattended in the outside playground for reportedly 8 minutes, during transition from playground to classroom. On 8/4/23, LPA interviewed D1 who corroborated incident and attempted to interview C1 who did not qualify to be interviewed.

Title 22 deficiency is being cited on the attached 809-D, this is a repeat citation which occurred on 09/16/2022, civil penalty applies.

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.


LPA Mariani informed Director Erika Silva to provide a copy of this licensing report dated 08/04/2023 that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview was conducted, report was reviewed, and Appeal Rights were provided to the Director, Erika Silva.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Selena MarianiTELEPHONE: (916) 605-8974
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023
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 08/04/2023 12:41 PM - 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001825

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Director conducted staff training on 5/23/23 on Sight & Sound Supervision for Bathroom, Classroom and Playground.
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This requirement is not met as evidenced by: Based on the Unusual Incident Report submitted by the facility on 5/17/2023, reporting that Child 1 was without supervision of a teacher in the outside playground for at least 8 minutes. This poses an immediate health and safety risk to the children in care.
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Director submitted dated sign in training log from training conducted on 5/23/23 that shows 20 out of 22 staff attended training.

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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: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Selena MarianiTELEPHONE: (916) 605-8974
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023
LIC809 (FAS) - (06/04)
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