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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804323
Report Date: 11/07/2024
Date Signed: 11/07/2024 12:41:09 PM

Document Has Been Signed on 11/07/2024 12:41 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804323
ADMINISTRATOR/
DIRECTOR:		MARGARITA D. GUILLERMOFACILITY TYPE:
850
ADDRESS:23301 OLIVEWOOD PLAZA DRIVETELEPHONE:
(951) 924-1956
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 95TOTAL ENROLLED CHILDREN: 95CENSUS: 57DATE:
11/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:32 AM
MET WITH:Jesika Guillermo, DirectorTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
NARRATIVE
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On Thursday, November 7, 2024 Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced Case Management inspection to follow-up on an Unusual Incident Report (UIR) submitted to Community Care Licensing CCL on October 22, 2024. LPA met with Jesika Guillermo (Director) and toured the facility. LPA interviewed the Director and staff.

On October 22, 2024, CCL received information via UIR that on October 17, 2024, Child One (C1) had climbed a stack of cots (used for sleeping) and fell off of them. This resulted in visible bruising to C1's face. Interviews conducted, and evidence received revealed to LPA that proper and timely aid was provided to the injured child (C1) and their parent was notified.

On today's date, LPA toured the facility, and the classroom to which the incident took place. LPA found the cots stacked vertically and after measuring from the floor to the last cot on top, LPA found them to be approximately 3.5 feet in height.

Staff interviews conducted revealed that the stacked cots were in the same arrangement on the day of incident; however, they had just been moved to another area of the classroom that is under a shelf that protrudes from the wall. Staff interview revealed that the idea behind this was that children wouldn't be able to reach the top of the cots.


Continued on LIC809C
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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Document Has Been Signed on 11/07/2024 12:41 PM - It Cannot Be Edited


Created By: Jesse Gardner On 11/07/2024 at 11:21 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/08/2024
Section Cited
CCR
101229(a)

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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. This requirement was not being met as evidenced by:
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Licensee states that they will conduct in-service training with all staff on supervision of children in care. Additionally, Licensee states that they will seperate the stack of cots to two. Training is due by POC date.
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Based on interviews conducted, proper care and supervision was not provided to C1 on 10/17/24. This is an immediate health and safety risk 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:Deborah Mullen
LICENSING EVALUATOR NAME:Jesse Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024


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

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804323
VISIT DATE: 11/07/2024
NARRATIVE
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Interviews conducted and evidence obtained revealed that C1 had climbed to the top of approximately 20 cots (3.5 feet in height), and fell. Records reviewed confirmed that the facility was operating within proper staff to child ratios (1 teacher to 7 children) on day of incident; however, staff interview revealed that C1 is known to enjoy climbing the cots, and tested their ability to do so on the day of incident reaching and standing on the top of the stacked cots. Concluding this, C1 was able to jump from the cots ultimately sustaining injury to their face. A deficiency was cited on today's date for lack of supervision.

An exit interview was held with Jesika Guillermo and a copy of this report was issued along with copies of the LIC809D (deficiency page), LIC811 (confidential names list), Notice of Site visit, and Appeal Rights. The notice of site visit must be posted for 30 days. This report shall be public record for three years.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
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