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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313605049
Report Date: 04/21/2023
Date Signed: 04/21/2023 01:18:45 PM

Document Has Been Signed on 04/21/2023 01:18 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KINDERCARE LEARNING CENTER - SUNSET (SA)FACILITY NUMBER:
313605049
ADMINISTRATOR:TARA ROZAKFACILITY TYPE:
840
ADDRESS:2251 SUNSET BLVDTELEPHONE:
(916) 315-3399
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 0DATE:
04/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tara RozakTIME COMPLETED:
01:30 PM
NARRATIVE
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On 04/21/2023 Licensing Program Analyst (LPA) Jeremey McClain met with Licensing Representative Tara Rozak for an unannounced Case Management Inspection regarding an Unusual Incident Reported received via email on 04/18/2023.

At the time of inspection, no school age children were present. During today’s inspection, LPA conducted an interview with the director and reviewed documents related to the incident.

It was reported that on 04/17/2023, a child was left unsupervised in the facility bus in the parking lot of the facility for approximately an hour and forty-five minutes. The facility became aware that the child was left on the bus after a parent was leaving with their children. The child did not suffer any injuries as a result of the incident. Parent was immediately notified.

A Type A deficiency is cited on the subsequent page of this report. This report was reviewed with the licensing representative. LPA provided Appeal Rights and a Notice of Site Visit, which must remain posted for 30 days.

Type A Deficiency
LPA Jeremey McClain informed facility representative, Tara Rozak, that this report dated 04/21/2023, documents 1 Type A citation which shall be posted for 30 consecutive days as there was immediate risk to the health, safety, or personal rights of children in care.
Also, LPA Jeremey McClain informed the licensing representative, Tara Rozak, to provide a copy of this licensing report dated 04/21/2023, 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.
Posting Requirements
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2023
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 04/21/2023 01:18 PM - It Cannot Be Edited


Created By: Jeremey McClain On 04/21/2023 at 12:51 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KINDERCARE LEARNING CENTER - SUNSET (SA)
FACILITY NUMBER: 313605049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/21/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision. (a)The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation. This requirment was not met
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Staff completed training of busing supervision procedures on 04/18/2023. Staff #1 (staff who conducted the bus run on 04/17/2023) has been terminated since the incident occurred. Director has conducted visual observations of procedures being followed and documented. Director has
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as evidenced by the incident report submitted on 04/18/2023. It was reported that on 04/17/2023, child #1 was left unsupervised on the facility bus at the facility for approximately an hour and forty-five minutes. The staff at the facility became aware the child was left on the bus when they were informed by a parent. This posed(s) an immediate threat to the health and safety of children in care.
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updated the checklist for staff to ensure that all children are checked in during pick up at their schools and upon arrival at the facility. Civil penalty will be assessed.

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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:Keven Peters
LICENSING EVALUATOR NAME:Jeremey McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2023


LIC809 (FAS) - (06/04)
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