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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073402041
Report Date: 11/26/2024
Date Signed: 11/26/2024 03:35:36 PM

Document Has Been Signed on 11/26/2024 03:35 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
073402041
ADMINISTRATOR/
DIRECTOR:		KLOBERDANZ, JEANNIEFACILITY TYPE:
850
ADDRESS:6095 MAIN STREETTELEPHONE:
(925) 672-9370
CITY:CLAYTONSTATE: CAZIP CODE:
94517
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 45DATE:
11/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Jeannie KloberdanzTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst D. Campos conducted a Case Management inspection at the facility to follow up on a self reported incident that occurred on 11/08/2024. LPA met with Center Director Jeannie Kloberdanz who guided LPA on a tour of the facility. Present for this inspection were 9 staff and 45 children in care.

During the investigation LPA interviewed staff, reviewed records, and obtained copies of relevant documents. An incident occurred when a teacher was observed forcefully grabbing a child by the arm and pulling him away from the outdoor play yard. Per Director she did not witness the incident but an internal investigation was conducted while teacher was placed on administrative leave. As a result of the incident, the teacher was let go by the company.

The attached type A deficiency is cited today and must be corrected by the due date.
LPA informed Director that this report dated 11/26/2024 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care.

Also, LPA informed the Director to provide a copy of this licensing report dated 11/26/2024 that documents any Type A citation 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.


Exit interview conducted and report reviewed with Director Jeannie Kloberdanz.
Notice of Site Visit provided must remain posted for 30 consecutive days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Diana Campos
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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 11/26/2024 03:35 PM - It Cannot Be Edited


Created By: Diana Campos On 11/26/2024 at 01:41 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 073402041

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/27/2024
Section Cited
CCR
101223(a)(1)(3)

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Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to:
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Director shall submit by close of business on the POC date, a plan of action describing what measures will be taken to prevent this violation from happening again. Prior to today's visit, teacher was let go. Additionally, staff training on childrens personal rights shall be imparted and a copy of the training material and signature log of attendees must be submitted to LPA.
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 interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by: Teacher was observed forcefully grabbing a child by the arm and pulling him away from the outdoor play yard which poses an immediate 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:Sherelle Johnson
LICENSING EVALUATOR NAME:Diana Campos
LICENSING EVALUATOR SIGNATURE:
DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/26/2024


LIC809 (FAS) - (06/04)
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