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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313605611
Report Date: 01/29/2024
Date Signed: 01/29/2024 12:48:46 PM

Document Has Been Signed on 01/29/2024 12:48 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KINDERCARE LEARNING CENTER - SIERRA COLLEGE (PS)FACILITY NUMBER:
313605611
ADMINISTRATOR:ANDREANA THORNSBERRYFACILITY TYPE:
850
ADDRESS:8765 SIERRA COLLEGE BOULEVARDTELEPHONE:
(916) 789-9898
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 95TOTAL ENROLLED CHILDREN: 95CENSUS: 47DATE:
01/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Andreana ThornsberryTIME COMPLETED:
12:55 PM
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Licensing Program Analyst (LPA) Jeremey McClain met with facility representative Andreana Thornsberry for an unannounced Case Management Inspection regarding an Unusual Incident Report.

Upon arrival, LPA observed 47 children supervised by six staff members.

On 01/25/2024 it was reported that on the same day, Child 1 was transported to the hospital by ambulance after suffering what was thought to be a seizure. The child had tensed their body up before falling backwards, hitting their head on the tile floor in the classroom and passed out. Staff immediately attended to the child notified their parents. Paramedics were contacted.

During today’s inspection LPA spoke with Staff 1 and Staff 2 who observed the incident. Interviews were consistent with what was documented on the unusual incident report. LPA also observed the area where the accident occurred.

LPA determined that the incident was not due to a lack of supervision or neglect. No Title 22 deficiencies occurred during the incident or were observed during today’s inspection. Exit interview conducted and report was reviewed by facility representative Marci Pilgrim. LPA provided a Notice of Site Visit that shall remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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