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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801327
Report Date: 10/21/2022
Date Signed: 10/21/2022 12:18:46 PM


Document Has Been Signed on 10/21/2022 12:18 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, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
103801327
ADMINISTRATOR:AVALOS, TASHAFACILITY TYPE:
830
ADDRESS:1785 VILLA DRIVETELEPHONE:
(559) 297-1888
CITY:CLOVISSTATE: CAZIP CODE:
93612
CAPACITY:34CENSUS: 11DATE:
10/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tasha Avalos - DirectorTIME COMPLETED:
12:30 PM
NARRATIVE
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On 10/21/22 Licensing Program Analyst (LPA) Joseph Pacheco arrived at the facility to conduct an unannounced case management inspection. LPA met with Director, Tasha Avalos to discuss an unusual incident that facility self-reported to the Fresno Child Care Regional Office on 9/26/22. On 9/23/22 day care staff were changing Child #1’s diaper. During the diaper change, staff observed blood on the inside of the diaper. Child #1’s authorized representative was contacted and taken to their doctor for an examination. Injury was determined to be due to a scratch but a cause of the scratch was unable to be determined. Facility staff fulfilled Mandated Reporter requirements and reported the situation to Child Protective Services (CPS) who determined the situation “Does not meet the requirements for intervention”. Child #1 continues to attend the facility and has had no further issues. This appears to be an isolated incident and staff took appropriate measures to address the child’s injury, following appropriate policies, regulations and reporting requirements. While taking a census of the Infant Room, LPA observed Child #2 asleep in a crib while being wrapped up in a blanket. LPA reviewed the files of Child #1 and Child #2. Staff were interviewed during today’s inspection.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D). Licensee was provided a copy of their appeal rights.

Exit interview conducted and report was reviewed with Director, Tasha Avalos.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022
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 10/21/2022 12:18 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, 1310 E. SHAW AVE,
FRESNO, CA 93710


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 103801327

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2022
Section Cited

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Infant Care Center Sleeping Equipment. Cribs shall be free from all loose articles and objects, including blankets and pillows. This requirement was not met as evidenced by observation. While taking a census LPA observed Child #2 asleep in a crib while wrapped up in a blanket.
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This is a potential risk to the health, safety or personal rights of children in care.
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and a copy of the sign in form showing what staff attended by 11/4/22.

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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: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2022
LIC809 (FAS) - (06/04)
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