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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001838
Report Date: 02/15/2023
Date Signed: 02/15/2023 01:22:20 PM


Document Has Been Signed on 02/15/2023 01:22 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:
483001838
ADMINISTRATOR:FIELDS, DONJEFACILITY TYPE:
850
ADDRESS:35 ROTARY WAYTELEPHONE:
(707) 557-3007
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:72; 72CENSUS: 44DATE:
02/15/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Justice Willis - Assistant Center DirectorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted a Case Management - Legal/Non-Compliance visit to the facility and met with Assistant Center Director, Justice Willis (AD). On 02/12/21, the facility attended an Informal Conference with the Department to discuss concerns relating to prior substantiated complaints and compliance with CCL/local public health COVID guidelines. On 12/21/21, the facility attended a Non-Compliance Conference (NCC) with the Department to discuss multiple citations which were issued for four separate complaint investigations that resulted in substantiated findings. The concerns discussed were related to a type A violation and $1000 civil penalty for repeat immediate civil penalty of the same violation within a 12-month period. The issue focused on lack of care and supervision resulting in a consistent pattern of children sustaining injuries, lack of staffing which prevented staff from consistently checking children's diapers, facility not maintaining the required staffing ratios, the facility allowing unqualified staff to supervise more children than permitted, and not notifying parents of unusual incidents.

The Department previously referred the facility to the Technical Support Program (TSP) which is a non-enforcement program that consists of on-site consultation visits and during the NCC and at that time, the facility voluntarily agreed to participate in TSP to receive additional training, resources, and address concerns in areas discussed in the NCC.

During today’s visit, the facility was toured inside and outside, and staffing ratios were being met. There were 44 children being supervised by four teachers and one Aide with at least six Early Childhood Education (ECE) units, and the facility was operating within the licensed capacity. According to AD, since the facility attended the NCC, the facility hired between four to five Aides to bolster staffing, and the additional staff helped in bolstering the care and supervision of the children, child(ren)'s diaper are on an hourly basis, and there is reduction in biting incidents and/or injuries to child(ren).

(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: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
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 4


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: 483001838
VISIT DATE: 02/15/2023
NARRATIVE
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Additionally, the facility utilized methods such redirection, sent children home, and consulted with its Inclusion team to address children's challenging behavior(s). The facility continued to seek for and interviewed prospective candidates that are fully qualified with completion of 12 Early Childhood Education (ECE) core units, and AD with collaboration of the Center Director (CD) obtained proof of and reviewed each staff(s) qualification to ensure that unqualified staff did not supervise more children than permitted. AD further claimed that additional staff assisted each classroom to maintain a teacher child ratio of 1:12 or 2:18 and the facility also rotated child(ren) to different classroom(s) to further ensure compliance with ratio requirements. AD informed the facility conducted monthly training for staff which included online/virtual or in-person to discuss topics related to CCL regulatory requirements and updates, and the facility is currently not participating in TSP, however; AD expressed continued interest in and agreed to participate in TSP.

AD stated when an incident occurred, the facility ensured that parents and Community Care Licensing Division (CCLD) were notified of incident(s) by notifying parent(s) via telephone, producing Incident/Accident report(s) to provide to parent(s), and/or submit Unusual Incident Report (UIR) to CCLD. AD stated the facility was willing and agreed to produce and submit to CCLD a template of the facility's new communication log which would be placed on a clip board and posted in each classroom for staff to access and communicate, and AD felt this new tool would either reduce or prevent mis-communication between staff during shift changes.

A review of Department records on 02/15/23 indicates not all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. AD confirmed adults (A1) provided care and supervision to the children in care and worked at the facility for at least than five days between August 2022 through February 2023, while adult (A2) provided care and supervision to the children in care for at least five days between August 22, 2022 through August 31, 2022; and such an immediate $1000 Civil Penalty is being assessed because A1 & A2 did not obtain an approved criminal record clearance prior working at the facility. Facility representative was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/15/2023 01:22 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: 483001838

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/16/2023
Section Cited

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All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department or
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Assistant Director stated A1 was provided with the LIC 9163 to get livescan, A1 would not work at the facility until A1 obtained an approved criminal record clearance,and A2 no longer worked at the facility. Assistant Director would submit the completed LIC 9163 with vendor signature to the Department by 02/16/23.
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This requirement is not met as evidenced by: Based on LPA's interview with AD and a review of Department records confirming A1 & A2 did not obtain an approved criminal record clearance. This poses an immediate health, safety and/or personal rights risk to the children in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099

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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: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4


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: 483001838
VISIT DATE: 02/15/2023
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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 the facility representative, Justice Willis.

LPA, Melchisedeck Augustin informed facility representative, Justice Willis that this report dated 02/15/2023 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA, Melchisedeck Augustin informed the facility representative to provide a copy of this licensing report dated 02/15/2023 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4