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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402041
Report Date: 12/19/2023
Date Signed: 12/19/2023 01:22:31 PM


Document Has Been Signed on 12/19/2023 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
073402041
ADMINISTRATOR:KLOBERDANZ, JEANNIEFACILITY TYPE:
850
ADDRESS:6095 MAIN STREETTELEPHONE:
(925) 672-9370
CITY:CLAYTONSTATE: CAZIP CODE:
94517
CAPACITY:72CENSUS: 59DATE:
12/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Jeannie KloberdanzTIME COMPLETED:
01:30 PM
NARRATIVE
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On 12/19/23 at 12:45pm, Licensing Program Manager (LPM) Loretta Dyson at the center for an unannounced case management inspection. LPM met with Jeannie Kloberdanz. There were 59 children and 8 additional staff also present.

The facility completed the required lead testing of water outlets, and outlet AA was found to be in exceedance of the Action Level of 5 ppb. The outlet was located outside in the toddler yard. LPM observed that the outlet has now been permanently removed, and the director advised that this was done shortly after they were notified of the test results. The director stated that they did post the test results right after the test results were received, to notify parents.

See LIC 809D for a deficiency being cited today. An exit interview was conducted with Jeannie Kloberdanz, and a copy of this report, a Notice of Site Visit, and appeal rights were provided. The facility was reminded to have the Notice of Site Visit posted for 30 days.
SUPERVISOR'S NAME: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2023
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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Document Has Been Signed on 12/19/2023 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 073402041

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2023
Section Cited
CCR
101700.3(b)(1)

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an
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LPM observed that the facility has permanently removed the outlet.
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Action Level Exceedance.
This requirement has not been met as evidenced by the lead testing results received, indicating that one outlet on the grounds of the facility had results in exceedance of the 5 ppb Action Level. This posed a potential risk to the 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: Diane PerezTELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: 510-695-0243
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2023
LIC809 (FAS) - (06/04)
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