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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001837
Report Date: 11/29/2023
Date Signed: 11/29/2023 02:53:40 PM


Document Has Been Signed on 11/29/2023 02:53 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 CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001837
ADMINISTRATOR:CANARIOS, ROSEFACILITY TYPE:
830
ADDRESS:35 ROTARY WAYTELEPHONE:
(707) 557-3007
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:36CENSUS: 22DATE:
11/29/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Donje Fields- Center DirectorTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Cindy Castro conducted an unannounced Plan of Correction (POC) visit and met with Center Director to follow up on prior outstanding deficiencies for child files and staff files.

During today's visit, LPA conducted a headcount and 22 children, being supervised by 5 staff. LPA requested to review five children's records and they were complete and contained completed LIC700 forms and updated Infant Services and Needs Plans with parental signatures. LPA requested to review 3 staff records, they were complete and contained immunization records and LIC503 forms. POC's were cleared and copies of letters were provided to Center Director.

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. Exit interview conducted and report was reviewed with Center Director, Donje Fields.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Cindy CastroTELEPHONE: (707) 867-6190
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
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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