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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493003399
Report Date: 12/10/2019
Date Signed: 12/10/2019 11:33:39 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
493003399
ADMINISTRATOR:KRISTEN AMARALFACILITY TYPE:
850
ADDRESS:1485 N. MC DOWELL BOULEVARDTELEPHONE:
(707) 794-0211
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:85CENSUS: 67DATE:
12/10/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Kristen AmaralTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Jennifer Velasco conducted an unannounced case management inspection re: an Unusual Incident Report (UIR) filed by director (D1) about a 10/23/2019 incident in which a child (C1) in care entered the classroom without staff supervision for several seconds before staff retrieved them. Facility reported the incident to CCLD on 10/24/2019.

During the inspection, LPA observed 67 children receiving care and supervision from 15 staff. The facility was operating within licensed capacity and ratio requirements. LPA obtained a current roster of children in care and other facility documents, reviewed facility records, and reviewed with D1 the facility's procedures for preventing and responding to supervision issues, including elopements. At 10:00 a.m., LPA interviewed two staff (S1 and S2) and one child (C1). Interviews and document reviews corroborated that the facility was operating within ratio and capacity requirements and that parents were retrieving their children from the playground during pick up time when the incident occurred. Interviews and documentation corroborated that C1 entered the classroom with the parents of another child and that staff (S1-S2) noticed this within several seconds and retrieved C1. D1 stated that because of this incident, she has separated children by age groups in the late afternoon and has scheduled additional staff to ensure no children can enter classrooms or elope during these transition periods. Interviews corroborated that staff told C1's parents immediately, took reasonable precautions to ensure children were supervised while in care and took immediate steps to update procedures to ensure children are supervised to prevent lack of supervision and elopement during pick-up and drop-off times. LPA consulted with D1 about this incident and this report. No deficiencies were cited during this inspection. A Notice of Site Visit is to be posted for 30 days.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
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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