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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804332
Report Date: 12/07/2021
Date Signed: 12/08/2021 07:57:56 AM

Document Has Been Signed on 12/08/2021 07:57 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804332
ADMINISTRATOR:RUBALCABA,BRANDIEFACILITY TYPE:
850
ADDRESS:5445 CANYON CRESTTELEPHONE:
(951) 683-1626
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 58DATE:
12/07/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Director Brandie RubalcabaTIME COMPLETED:
01:00 PM
NARRATIVE
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On 12/07/2021 at 09:45am, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct an inspection for a separate purpose. During this inspection, LPA toured the facility, took census and verified staff's criminal record clearances and association to facility.

While touring the facility and verifying facility associations, LPA Hogue observed three staff members present and working at the facility without an Eligible Criminal Record Clearance.

In accordance with Title 22 Regulation, 101170(h) Violation of Section 101170(e) will result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the Department.

See LIC809D for cited deficiency. A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.

Upon receipt of this report, the Director shall post any licensing report documenting a Type A deficiency (LIC809 & LIC809D). The report and the Notice of Site Visit shall be posted for 30 days. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months. The Acknowledgement of Receipt (LIC9224) form must be maintained in each child’s file immediately upon receipt from the parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC9224). An exit interview was conducted, and a copy of this report and appeal rights (LIC9058) was provided to Director Brandie Rubalcaba on this date.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Destinee Hogue
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2021
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 12/08/2021 07:57 AM - It Cannot Be Edited


Created By: Destinee Hogue On 12/07/2021 at 12:05 PM
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804332

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/08/2021
Section Cited
CCR
101170(e)(1)

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101170(e)(1) Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption...
This requirement is not met as evidenced by:
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Immediately (within 24 hours), Director removed Staff #1 from the facility and completed LIC9163-Request for Live Scan for Staff #1 to be refingerprinted. During this inspection, Director uploaded, LIC9182-Criminal Background Clearance Transfer Request, LIC508-Criminal Record Statement, and
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Based on records review and observation, the Director did not comply with the section cited above in which LPA Hogue observed three staff members present and working at the facility without an Eligible Criminal Record Clearance. This poses an immediate health, safety, and personal rights risk to children in care.
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Copy of DL/ID card to Guardian website for Staff #2 and Staff #3. Director agrees to submit LIC9163 for Staff #1 and proof of Eligible Criminal Record Clearance for Staff #2 and Staff #3. A civil penalty is being assesed.

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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:Kimberly Williams
LICENSING EVALUATOR NAME:Destinee Hogue
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2021


LIC809 (FAS) - (06/04)
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