<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001828
Report Date: 09/04/2024
Date Signed: 09/04/2024 04:20:45 PM


Document Has Been Signed on 09/04/2024 04:20 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001828
ADMINISTRATOR:HAYMER, MORNENFACILITY TYPE:
850
ADDRESS:581 PEABODY ROADTELEPHONE:
(707) 447-7685
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:75CENSUS: 26DATE:
09/04/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Brenda Hardaway - Center Director TIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An Annual/Required inspection of the facility was conducted by Licensing Program Analyst (LPA) Melchisedeck Augustin, who met with Director, Brenda Hardaway. The facility file was reviewed prior to this inspection. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. The facility is not registered with Solano Family and Children’s Services, Food Program, and does not operate under Title 5. The facility did not have any active waivers on file.

The facility’s operating hours are from 6:30 AM - 6:00 PM Monday-Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The sign-in/sign-out records were reviewed and appeared to be in compliance. Items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be out of reach, inaccessible to children. Director stated poisons are not stored on site and none were observed by LPA. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is drinking water available to children indoors and outdoors and the facility provided children with bottled water. The children's bathrooms are in safe and sanitary condition. There is at least one sink and toilet for every 15 children. There is 35 square feet indoor and 75 square feet outdoor per child. The Menu was posted on the parent board near the entrance, and the activity schedules were posted in each classroom. The facility had its own internal food program which provided snacks and lunch for the children. Garbage cans containing solid waste have tight fitting lids. LPA observed a working carbon monoxide detector, smoke alarm, and fire extinguisher rated at least 2A10BC in the facility. Last emergency drill was conducted on 06/04/24. (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: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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 6


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001828
VISIT DATE: 09/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The playground equipment and surface areas are in safe condition. There is wood chip cushioning and artificial turf underneath the climbing structures and/or play equipment to absorb falls. There are no bodies of water observed on the site. Director stated no weapons are stored on site, and none were observed. During today's inspection, staffing ratios were being met, and 26 children were supervised by five teachers. The facility was operating within the licensed capacity requirements. At least one staff member present during the inspection possessed current CPR and First Aid certifications, which expire on 04/22/2025. Five staff (S1-S5) records were reviewed at 12:19 PM which revealed S1 was missing required Immunization Record (IR) and evidence of negative Tuberculosis (TB) clearance, Health Screening (LIC 503), Employee Rights (LIC 9052), and LIC 9108. S2 was missing proof of immunity against Measles, S3 was missing Personnel Record (LIC 501), LIC 503, LIC 9052, IR, and LIC 9108. S4 was missing licensing forms: 501, 503, 9052, and IR, and S5 was missing LIC 503 and proof of immunity against Influenza. Five children’s (C1-C5) records were reviewed at 1:12 PM which revealed C1’s Immunization Record (IR) was transcribed on incorrect CDPH 286, Enrollment Agreement not signed by parent, C2’s Enrollment Agreement not signed by parent and missing CDPH 286, C3 is missing CDPH 286 and LIC 701 and enrollment agreement not signed by parent; & C5 was missing LIC 701 & LIC 702 was not signed by the parent. The facility roster of the children in care was reviewed and appeared to be complete.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP). LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/. (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: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001828
VISIT DATE: 09/04/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.


To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

The following violations of the California Code of Regulations, Title 22, Division 12, were cited: see LIC809-D. Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Center Director, Brenda Hardaway.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 09/04/2024 04:20 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001828

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on five staff (S1-S5) records reviewed which revealed S1-S5's required Immunization Records (IR) were missing or incomplete. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
1
2
3
4
Director said she would notify staff of the missing Immunization Records, obtain the records and submit all required records to the department by 09/25/24. Email: melchisedeck.augustin@dss.ca.gov & FAx: 707-588-5099
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) 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:
Deficient Practice Statement
1
2
3
4
Based on five staff (S1-S5) records reviewed which revealed S1& S3-S5 were missing Health Screening (LIC 503). The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
1
2
3
4
Director said she would notify S1 & S3-S5 of missing LIC 503, obtain the completed LIC 503, and submit evidence of completion of the form, to the department by 09/25/24. Email: melchisedeck.augustin@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: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
LIC809 (FAS) - (06/04)
Page: 4 of 6


Document Has Been Signed on 09/04/2024 04:20 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001828

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(l)(1)(B)
Personnel Requirements
(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on five staff (S1-S5) records reviewed which revealed S1 & S3-S4 were missing Employee Rights (LIC 9052). The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
1
2
3
4
Director said she would provide the LIC 9052 to S1 & S3-S4, obtain staff's signature on the forms, and submit a copy of the signed forms to the department by 09/25/24. Email: melchisedeck.augustin@dss.ca.gov & FAx: 707-588-5099
Type B
Section Cited
CCR
101220(a)(1)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. (1) Such assessment shall be performed by, or under the supervision of, a licensed physician, and shall not be more than one year old when obtained.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on five children's (C1-C5) records reviewed which revealed C3 & C5 were missing Physician Report (LIC 701). The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
1
2
3
4
Director said she would provide C3 & C5's parents with LIC 701, obtain the completed forms from the parents, and submit a copy of the completed forms to the department by 09/25/24. Email: melchisedeck.augustin@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: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 09/04/2024 04:20 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001828

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101220.1(g)
Immunizations
(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on five children's (C1-C5) records reviewed which revealed C1-C3 & C5's Immunization were transcribed on incorrect or missing CDPH 286. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
1
2
3
4
Director said she would document C1-C3 & C5's Immunization Record onto the correct blue CDPH 286, and Director intends to submit transcribed CDPH 286 to the department by 09/25/24. Email: melchisedeck.augustin@dss.ca.gov & FAx: 707-588-5099
Type B
Section Cited
CCR
101221(b)(6)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (6) A signed copy of the admission agreement specified in Section 101219.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on five children's (C1-C5) records reviewed which revealed C1-C3's Enrollment Agreements were not signed by the parents. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/25/2024
Plan of Correction
1
2
3
4
Director said she would provide C1-C3's parents with the Enrollment Agreement and ensure she parent signed the forms, and Director intends to submit copies of the signed forms to the department by 09/25/24. Email: melchisedeck.augustin@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: 09/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
LIC809 (FAS) - (06/04)
Page: 6 of 6