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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001834
Report Date: 03/14/2023
Date Signed: 03/14/2023 05:05:48 PM


Document Has Been Signed on 03/14/2023 05:05 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: DATE:
03/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:16 PM
MET WITH:Assistant Center Director Sharin RashidianTIME COMPLETED:
05:15 PM
NARRATIVE
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On 03/14/2023, Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrived to the facility for the purpose of conducting record review and interviews on another license in the facility. While walking down the hall LPA observed the "toddlers" room under the infant license which had 18 infants and two staff members. LPA was concerned of five children in the room during the nap/rest period. LPA approached Staff one ( S1) and asked for the sleep log to the infants, S1 reported the lead teacher (S3) was in charge of the sleep logs. LPA exited the room to find S3 to review the Sleep logs for the infants. LPA found S4 who was able to help find the sleep logs binder. S4 produced the Sleep Log Binder, which had Sleep Logs from March 06th 2023 and older. There was no current sleep Logs for the 18 infants in care in the "Toddlers" room. A type B deficiency was cited on 809-D page.

Report was reviewed with center representative and appeal rights were provided.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez TorresTELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023
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 2


Document Has Been Signed on 03/14/2023 05:05 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: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2023
Section Cited

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Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Date. Infant’s name. Time of each 15-minute check.Initials of staff person who
conducted each check.
This was not met as evidence by. . .
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The assistant center director agreed to have all staff undergo Infant Safe Sleep Training through TSP. LPA printed " Responsibility for providing care and supervision for infants" and reviewed the requirements with the assistant center director. Assistant center Director agreed to email over the safe sleep log for three infants to LPA on 03/28/2023.
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Based on observation, record review and staff interview the center was not complying with the regulation stated above for the 18 infants that were in the toddlers room since March 06th 2023. This poses a potential health and safty risk to childrfen 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: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023
LIC809 (FAS) - (06/04)
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