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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334804334
Report Date: 02/09/2024
Date Signed: 02/09/2024 04:46:40 PM

Document Has Been Signed on 02/09/2024 04:46 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: 20DATE:
02/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Brandie RubalcabaTIME COMPLETED:
05:00 PM
NARRATIVE
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On this date and time, Licensing Program Analyst (LPA) Laura Mejorado arrived at the facility to conduct a case management visit in response to the receipt of an unusual incident report (UIR). The UIR was received by the licensing agency on 02/05/24. Upon arrival, LPA met with facility Director Brandie Rubalcaba and stated the purpose of the visit. Records were reviewed and interviews were conducted.

Facility self reported that on 02/02/24 an infant was moved from the infant classroom to the toddler classroom and within minutes a staff member noticed the infant had red around their mouth. When staff went to go check on the infant, they noticed a red pill in the infant’s mouth and immediately removed it. The infant’s mouth was immediately washed along with their face and hands. Staff did not notice any residue of the pill inside the infant’s mouth and only noted the infant had red around their mouth. It was later stated the red pill was an over the counter pain pill. The parent was immediately notified. The infant was observed and did not show any signs of illness, lethargy, or vomiting. Parent did not seek medical attention. Interviews disclosed that medication is not stored in the classroom. Staff store their personal belongings in a locked cabinet and deny have any medication in their personal belongings. After the incident the classroom was swept, and furniture was moved around to ensure nothing else was on the floor. Staff is unaware of how the pill got in the classroom.

Based on the information gathered, staff were present during the incident and took appropriate actions and self-reported the incident within a timely matter. However, that did not prevent the infant from putting an unknown pill in their mouth.

See LIC809D for cited deficiency of the California Code of Regulations, Title 22.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Brandie Rubalcaba.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2024
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 02/09/2024 04:46 PM - It Cannot Be Edited


Created By: Laura Mejorado On 02/09/2024 at 04:20 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: 334804334

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2024
Section Cited
CCR
101223(a)(2)

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(a) The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director agrees to provide in-service training with all staff over inspecting the classrooms for any hazards and the handling of any medication by staff while at the facility and provide a sign-in sheet of all staff present and what was discussed to CCL by 2/20/24.
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Based on record review and interviews, an infant had an unknown pill in their mouth, which poses a potential health, safety or personal rights risk to persons in care.
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Director stated they have a professional development day scheduled on 2/19/24 and will be including these topics during this training.

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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:Laura Mejorado
LICENSING EVALUATOR SIGNATURE:
DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/09/2024


LIC809 (FAS) - (06/04)
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