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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804323
Report Date: 11/02/2022
Date Signed: 11/02/2022 12:34:46 PM

Document Has Been Signed on 11/02/2022 12:34 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804323
ADMINISTRATOR:MARGARITA D. GUILLERMOFACILITY TYPE:
850
ADDRESS:23301 OLIVEWOOD PLAZA DRIVETELEPHONE:
(951) 924-1956
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 42DATE:
11/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:29 PM
MET WITH:Jesika GuillermoTIME COMPLETED:
12:45 PM
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On November 2, 2022 at 12:29 PM, Licensing Program Analyst Licensing Program Analyst’s (LPA’s) Anastasia Flores and Jessica Rubio arrived at the facility and met with Jesika Guillermo in regard to an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 10/24/22.

It indicates that while running, child #1 (C1) tripped and fell forward and hit his forehead on the second step of the play structure resulting in an injury that needed medical attention.

Interview was conducted with S2. Based on information gathered, the facility acted appropriately, and no violations have been identified. The facility immediately contacted the parents and emergency services.

An exit interview was conducted, and a copy of this report was provided to facility staff.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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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