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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001834
Report Date: 01/03/2023
Date Signed: 01/03/2023 05:25:52 PM


Document Has Been Signed on 01/03/2023 05:25 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:
483001834
ADMINISTRATOR:WENDY CERTEZAFACILITY TYPE:
830
ADDRESS:1611 WOOD CREEK DRIVETELEPHONE:
(707) 426-2275
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:36CENSUS: 21DATE:
01/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
05:05 PM
MET WITH:Facility Representative Arianna KalistaTIME COMPLETED:
05:40 PM
NARRATIVE
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Licensing Program Analysts ( LPAs) Melchisedeck Augustin and Elpidia Hernandez Torres arrived to the facility to deliver findings. Upon LPAs arrival, the Center Director nor Assistant Center Director were present at the facility and the facility representative (S1) was present in the office. LPAs requested qualifications for S1, but S1 was not able to furnish the qualifications stating they were locked in a file which only the assistant center director has a key of. While LPAs were In the office, LPAs observed a stroller with a car seat attached to it with infant (C1) sleeping inside. LPAs asked if C1 was S1's infant, S1 confirmed she was the parent of C1 and the infant was having trouble sleeping in the room, and fell asleep in the stroller; S1 then pushed the stroller to the Tods classroom. LPAs conducted a head count of the infants and noticed the stroller in the classroom with no child in it. LPA Hernandez Torres asked staff S2 if C1 was in the stroller, S2 confirmed C1 was in the stroller and is enrolled in the classroom. An Advisory note was issued.

While LPAs were speaking with S1, another staff member (S3) arrived and relieved S1 to go back to their classroom. S3 was now taking over as the designated representative. LPAs asked S3 for her qualifications and S3 stated her qualifications were in her file locked in the filing cabinet which only the assistant center director had access to. California code of regulations title 22 division 12 chapter 1 101217 (c) is being cited on 809-D.

Exit Interview was conducted, report was reviewed with facility representative Arianna Kalista. Notice of site visit was given and must remain posted for 30 days. Appeal rights were given.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez TorresTELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023
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 01/03/2023 05:25 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: 483001834

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2023
Section Cited

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All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This was not met as evidence by. . .
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Facility Representative S3 has agreed to submit qulifications to LPA Hernandez Torres via email, mail or fax on or before 01/17/2023.

Email: elpidia.hernadnez-torres@dss.ca.gov
Mail: 1450 Neotomas Ave Suite 100 Santa Rosa CA 95405
Fax: 707-588-5099
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Based on interviews, both S1 and S3 reported they did not have access to their records due to their personal records being locked in a cabinet only the assistant center director has access to. This poses an potential health and safety risk to 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: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez TorresTELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2023
LIC809 (FAS) - (06/04)
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