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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804329
Report Date: 09/19/2024
Date Signed: 09/19/2024 11:36:25 AM

Document Has Been Signed on 09/19/2024 11:36 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804329
ADMINISTRATOR/
DIRECTOR:
THERESA SALLEYFACILITY TYPE:
850
ADDRESS:11961 PERRIS BLVDTELEPHONE:
(951) 243-6558
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 72TOTAL ENROLLED CHILDREN: 54CENSUS: 51DATE:
09/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:43 AM
MET WITH:Theresa SalleyTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On the date and time listed, Licensing Program Analyst (LPA) Sumayya Habeebulla arrived at the facility to conduct a Case management incident follow-up visit on an Unusual Incident Report (UIR) received by the Department on 09/06/24. LPA met with facility director Theresa Salley to discuss the incident. A tour of the facility was granted, and census was conducted.

It was reported to the department that on 09/05/24, during nap time, S3 observed C1 move and approached the child to check on the child. S3 observed that C1 had vomited and looked dazed. S3 immediately notified facility director about the incident and started to clean up the child and the child was non-responsive. Facility director called 911 and notified parent. Once paramedics arrived child went into full seizure and medication was administered by paramedics and child was taken to the hospital for evaluation. Since the incident the child has returned to the facility and facility has requested parent to complete a plan in case of a future incident. Facility is working with family to complete the information and create a plan to ensure the safety of the child. There have been no prior health incidences with C1 at the facility.

LPA has determined that the facility has taken the necessary steps and is ensuring proper supervision was provided to ensure the health and safety of the children in care.

Based on the information gathered, there appears to be no violations of Title 22 Regulations found at this time, and therefore, there were no deficiencies cited during this visit.

An exit interview was conducted, and a copy of this report was provided to Ms. Theresa Salley. A Notice of Site Visit was issued, and the director understands that it must remain posted for 30 days.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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