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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313605610
Report Date: 04/21/2023
Date Signed: 04/21/2023 10:53:36 AM

Document Has Been Signed on 04/21/2023 10:53 AM - 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 - SIERRA COLLEGE (INF)FACILITY NUMBER:
313605610
ADMINISTRATOR:ANDREANA THORNSBERRYFACILITY TYPE:
830
ADDRESS:8765 SIERRA COLLEGE BOULEVARDTELEPHONE:
(916) 789-9898
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 22DATE:
04/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Andreana ThronsberryTIME COMPLETED:
11:00 AM
NARRATIVE
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On 04/21/2023, Licensing Program Analyst (LPA) Jeremey McClain met with Licensing Representative Andreana Thornsberry for an unannounced Case Management Inspection regarding an Unusual Incident Reported received via email on 04/18/2023.

LPA observed care and supervision of 22 infants supervised by eight staff in three separate rooms. During today's inspection, LPA conducted staff interviews, reviewed children's file, and observed the infant classroom the incident occurred in.

It was reported that on 04/17/2023, at approximately 11:50 am, a child suffered an allergic reaction while in care. The child began coughing, vomiting, and developed hives. Staff at the time administered emergency medical procedures and also contacted 911. The child was treated by the paramedics at the facility and later monitored at the hospital. The child returned to care the following day.

Deficiencies are cited on the following page of this report. This report was reviewed with the license. 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, Andreana Thornsberry, that this report dated April 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 facility representative, Andreana Thornsberry, to provide a copy of this licensing report dated April 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 10:53 AM - It Cannot Be Edited


Created By: Jeremey McClain On 04/21/2023 at 10:15 AM
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 - SIERRA COLLEGE (INF)
FACILITY NUMBER: 313605610

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
101223(a)(2)

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Personal Rights. (a)The licensee shall ensure that each child is accorded the following personal rights:(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by staff interviews and incident
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The staff followed the emergency medical procedures during the incidents. The staff have developed a plan to ensure that the environment does not pose a risk for child #1 to come into contact with the allergen by designating a staff to supervise child #1 during and after feeding times. Staff are
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report submitted on 04/18/2023. It was determined that child #1 was not afforded a safe healthful accomodations. On 04/03/23 and 04/17/2023, child #1 suffered allergic reactions after coming into contact with an allergen during lunch. This posed an immediate risk to the health and safety of the child in care.
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 also working on other measures to lower the risk of exposure to the known allergen.

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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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