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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001829
Report Date: 04/11/2024
Date Signed: 04/11/2024 12:57:56 PM


Document Has Been Signed on 04/11/2024 12:57 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:
483001829
ADMINISTRATOR:HAYMER, MORNENFACILITY TYPE:
840
ADDRESS:581 PEABODY ROADTELEPHONE:
(707) 447-7685
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY:24CENSUS: 0DATE:
04/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Brenda Hardaway - Center DirectorTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin made an unannounced Case Management (CM) visit and met with the Center Director (CD), Brenda Hardaway, for the purpose of investigating circumstances surrounding an incident involving a staff (S1) which allegedly picked up and threw a child (C1) to the floor. On 04/09/24, the facility initially notified the Department of the incident by submitting a written Unusual Incident Report. During the today's visit, the school age children were not present as they were in school. LPA interviewed CD and staff (S2-S5), requested a personnel record, and obtained facility roster of the children currently in care.

According to CD's statement, she was not present during the alleged incident, however; CD did report that she spoke with multiple children in the class that confirmed S1 grabbed C1 by the arm because C1 did not do what S1 had asked. CD said immediately after the incident, she spoke with and removed S1 from the classroom, and the facility intends to initiate its own internal investigation.

A follow up visit is required to interview the children. Exit interview conducted and report was reviewed with the Center Director, Brenda Hardaway. Notice of Site Visit shall be posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. The were no Title 22 Deficiencies cited at this time.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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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