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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270364
Report Date: 08/17/2023
Date Signed: 08/17/2023 05:15:56 PM

Document Has Been Signed on 08/17/2023 05:15 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
304270364
ADMINISTRATOR:AMANDA BARLETTFACILITY TYPE:
850
ADDRESS:2515 EAST SOUTH STREETTELEPHONE:
(714) 774-5141
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 48TOTAL ENROLLED CHILDREN: 30CENSUS: 25DATE:
08/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Daisy Garcia Asst DirectorTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced case management visit as a result of observations made during today's inspection and observations made during a course of investigation. LPA met with Asst Director, Daisy Garcia since Director again was absent and unavailable. Director was not present on 07/31/23.

Upon entrance, Asst Director, Daisy Garcia was preparing lunch. LPA advised reason for visit and went to Room #3. Upon entrance LPA observed Staff#1(S1) Changing diapers. LPA observed 13 children in care.
In Room 4 there were 12 children in care and one teacher.

A review of the Facility Personnel Report Summary on this date indicates all facility staff, or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA viewed Child Supervision Record and noted 14 children had names on list, the 14th child was signed in at 9:35 but another child was signed out at 9:35 am. The 13th child was signed in at 8:46 am.

LPA interviewed S1 who indicated she was out of ratio beginning 8:46am. Interview with S1 indicated she had informed Asst. Director when her class became out of ratio. S1 also stated she was assisted with ratio after LPA advised Asst. Director, Garcia at approximately 10:25 am.

Interview with Asst. Director, Ms. Garcia divulged that she was assisting the infant program with their ratios this morning. Ms. Garcia also reported she had been aware of three teacher absences and director's absence and had reached out to on call employees but was unable to get coverage. Also, another teacher who usually works breaks had a scheduled morning off. LPA observed S2 arrive at 10:55am.
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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
Document Has Been Signed on 08/17/2023 05:15 PM - It Cannot Be Edited


Created By: Pat Rivas On 08/17/2023 at 02:14 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270364

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/18/2023
Section Cited
CCR
101216.3(a)

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Teacher-Child RatioThere shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, This requirement was not met as evidenced by LPAs observation of 13 children in room 3 and 1 teacher present and
review of Child Supervision Record
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Asst Director will contact sister facilities to obtain staffing in the interim, and will also impement using a temporary agency in the future, plan to be in writing and submitted to LPA Rivas by plan of correction date
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which showed 13 children were in care beginning 8:46am until approximately 10:20am this poses an immediate health and safety risk and personal rights violation to 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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023


LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270364
VISIT DATE: 08/17/2023
NARRATIVE
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During visit LPA observed S1 completing diapering of all children. The diapering was done on changing table and children's bathroom which did not allow for supervision of other children. During LPAs visit and with Asst Director present LPA observed children running in classroom, climbing cots and book shelves, throwing toys including but not limited to; blocks, dolls, dinosaurs. LPA did observe Asst. Director assisting children as she became aware of each incident.
During course of an investigation it was found that S2 is a teacher's aide but on 07/26/23 was alone with 12 children for approximately 30 minutes per her statement since S3 was on her way to relieve S1. S1 had handled the food delivery that day since both Director and Asst Director were absent. S2 further indicated that two of the children were finishing their lunch a couple of the children were not in bed(cot). S2 indicated she is an aide and is aware that she has to work under a qualified teacher.

Based on observations and records reviewed the following Type A and B deficiencies are cited under the California Code of Regulations Title 22 Division 12 Chapter 1; 101216.3(a) Teacher Child Ratio and
10126.2 (e) Teacher Aide Qualifications and Duties.

LPA Rivas informed Asst. Director Daisy Garcia that this report dated 08/17/2023 document(s) one Type A and one Type B deficiency which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.
Also, LPA Rivas informed Asst. Director Daisy Garcia to provide a copy of this licensing report dated 06/13/2023 that documents any Type A citation(s) 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 was reviewed with Asst. Director Daisy Garcia. 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.



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SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/17/2023 05:15 PM - It Cannot Be Edited


Created By: Pat Rivas On 08/17/2023 at 04:02 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270364

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/24/2023
Section Cited
CCR
10126.2(e)

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 Teacher Aide Qualifications and Duties.
n aide shall work only under the direct supervision of a teacher. on or about 07/26/23 this requirement was not met as evidenced by Interviews with staff who indicated S1 was processing food delivery while S2 was watching 12 children ; S2 's
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Training shall be conducted with staff to advise on supervision requirements, an lic 500 will be provided ; copy of sign in sheet will be provided to LPA Rivas via email
patricia.rivas@dss.ca.gov
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file did not have transcripts only lic 9025 indicating she had 3 units in infant school age at laguna technical college and 3 in noce;
she is an aide
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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:Rina Lopez
LICENSING EVALUATOR NAME:Pat Rivas
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2023


LIC809 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270364
VISIT DATE: 08/17/2023
NARRATIVE
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Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.. 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.

end of report

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5