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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073407464
Report Date: 04/22/2022
Date Signed: 04/22/2022 04:27:44 PM

Document Has Been Signed on 04/22/2022 04:27 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:
073407464
ADMINISTRATOR:ADEEBA AQMALFACILITY TYPE:
830
ADDRESS:4108 LONE TREE WAYTELEPHONE:
(925) 754-1236
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: DATE:
04/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:SHANNON REGACHOTIME COMPLETED:
04:30 PM
NARRATIVE
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3:15PM- LICENSING PROGRAM ANALYST TASHA ALEXANDER MET WITH CENTER DIRECTOR SHANNON REGACHO IN REGARDS TO A SELF REPORTED INCIDENT THAT HAPPENED ON 4/14/22 .

TODAY AN INTERVIEW WAS CONDUCTED WITH THE DIRECTOR AND IT WAS DISCOVERED THAT A STAFF MEMBER INAPPROPRIATELY DISCIPLINED CHILDREN IN CARE.

PLEASE SEE THE ATTACHED 809-D FOR CITATION


THE LIC 9224 ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS HAS BEEN GIVEN AND EXPLAINED. A COPY OF THIS REPORT MUST BE GIVEN TO EACH DAY CARE CHILD'S PARENT/GUARDIAN BY THE NEXT BUSINESS DAY. A COPY MUST ALSO BE GIVEN TO ANY NEWLY ENROLLED CHILD'S PARENT/GUARDIAN FOR UP TO 1 YEAR. THIS COPY MUST BE POSTED FOR 30 DAYS.

THIS REPORT MUST BE AVAILABLE FOR 3 YEARS.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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 04/22/2022 04:27 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 04/22/2022 at 04:08 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: 073407464

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/25/2022
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights
(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: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.- REQUIREMENT WAS NOT MET AS EVIDENCED BY: STAFF INAPPROPRIATELY DISCIPLINED CHILDREN IN CARE
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THE FACILITY HAS TAKEN ACTION AND TERMINATED THE STAFF MEMBER. AN INFORMAL CONFERENCE MAY BE SCHEDULED WITH THE FACILITY AT A LATER DATE WITH COMMUNITY CARE LICENSING.

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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:Loretta Dyson
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022


LIC809 (FAS) - (06/04)
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