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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804334
Report Date: 11/08/2022
Date Signed: 11/08/2022 01:55:54 PM

Document Has Been Signed on 11/08/2022 01:55 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334804334
ADMINISTRATOR:RUBALCABA, BRANDIEFACILITY TYPE:
830
ADDRESS:5445 CANYON CRESTTELEPHONE:
(951) 683-1626
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 17DATE:
11/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Brandie RubalcabaTIME COMPLETED:
02:00 PM
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On the date and time listed above, a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 10/20/22. It indicates a parent informed the facility of an unexplained injury on 10/19/22. An initial visit was conducted on 10/28/22 at which time interviews were conducted and records reviewed.

According to staff interviews conducted, there were 3 infants present with 1 staff. Staff interviews reported the infant last attended on 10/17/22 at which time parent received an ouch report for a scratch to nose and cheek due to infant tripping due to learning to walk. Staff reported on 10/19/22 parent reported an unexplained injury and is not sure when it occurred.



Parent interview stated they received ouch report for infant falling on carpet and confirmed infant is at the beginning stage of learning to walk. Parent also confirmed non-attendance of infant on 10/18/22 in addition to having a parent/facility conference on 10/28/22.

Child interview stated that their infant sibling is learning to walk and falls all the time at home and sometimes at daycare.

On 10/28/22 at 1:30PM, LPA toured and obtained photo of the infant indoor activity area and did not observe any hazards on the floor or carpet areas.

Based on information gathered from interviews and records, the facility acted appropriately, and no violations have been identified. Facility completed reporting requirements as required by CCR
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334804334
VISIT DATE: 11/08/2022
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regulations for Unusual Incident Reports (submission of LIC624) to the California Department of Social Services. Facility maintained staff to children ratios for supervision; maintained communication with parent and followed company procedures for additional communication with parents (conference)

An exit interview was conducted, and LPA Carbullido provided the Director with a copy of this report, appeal rights and notice of site visit during today’s visit.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022
LIC809 (FAS) - (06/04)
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