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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566205972
Report Date: 12/09/2022
Date Signed: 12/09/2022 01:58:19 PM


Document Has Been Signed on 12/09/2022 01:58 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:KINDERCARE LEARNING CENTER MPFACILITY NUMBER:
566205972
ADMINISTRATOR:IRINA ARTEMYEVAFACILITY TYPE:
850
ADDRESS:3987 SPRING ROADTELEPHONE:
(805) 529-1093
CITY:MOORPARKSTATE: CAZIP CODE:
93021
CAPACITY:96CENSUS: 42DATE:
12/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Irina ArtemyevaTIME COMPLETED:
02:13 PM
NARRATIVE
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On December 9, 2022 at 12:00 PM Licensing Program Analyst (LPA) Austin Rios conducted an unannounced case management inspection for a confirmation of removal for S1. LPA met with director Irina Artemyeva and discussed the nature and purpose of the inspection. Together both director and LPA conducted a tour of the facility inside and outside. There was 42 children in care at the time of the inspection.

Staff 1 was not present during the inspection. Director stated S1 was last present at the facility on 11/30/2022. The Department and director was notified that S1 was arrested on 12/1/2022. Director reported incident to the licensing office on 12/9/2022. LPA advised director of report requirements and to report unusual incidents like this to the department within 24 hours. California Code of Regulation, (Title 22 Division 12 and 10212(d)(1)(C) type B deficiency for reporting requirements is being cited on the attached LIC 809 D).

LPA advised director to stay apprised on legal proceeding regarding S1. Exit interview was conducted with director. Director was given a copy of the appeal rights and a notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022
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 12/09/2022 01:58 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: KINDERCARE LEARNING CENTER MP
FACILITY NUMBER: 566205972

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2022
Section Cited

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Reporting Requirements- (d) Upon the occurrence, ... of any of the events specified in (d)(1) below, a report shall be made to the Department...within the Department's next working day... In addition, a written report...specified in (d)(2) below...(1) Events reported shall include...(C) Any unusual incident...

This requirement is not met as evidenced by:
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Based on LPA interview with director it was determined that facility did not repoort to the deparment the arrest of S1 within 24 hours or by the next business day after learning about the incident on 12/6/2022 and did not report to the deparment until 12/9/2022 which poses a potential risk to the health and safety of 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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2022
LIC809 (FAS) - (06/04)
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