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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334812757
Report Date: 03/15/2023
Date Signed: 03/15/2023 04:36:07 PM

Document Has Been Signed on 03/15/2023 04:36 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334812757
ADMINISTRATOR:JESSICA SALVADOR-RIVERAFACILITY TYPE:
850
ADDRESS:1080 HIGHGROVETELEPHONE:
(951) 371-9346
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 92TOTAL ENROLLED CHILDREN: 92CENSUS: 71DATE:
03/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Jessica Salvador-RiveraTIME COMPLETED:
04:46 PM
NARRATIVE
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One date and time listed above, Licensing Program Analysts, (LPAs) Claudia Caywood and Justin Giese made an unannounced visit to the Facility for the purpose of following up on a submission of an Unusual Incident Report (UIR) which was received by the Department on 02/24/2023. LPAs met with Facility Director Jessica Salvador-Rivera to discuss purpose of visit.

On 02/15/2023, Staff was transitioning children back to their classroom from the play ground. UIR reported children were lined up awaiting to go inside the classroom. Staff then opened the classroom door in an attempted to go inside, two children ran out of line and back to the playground. During this time, it was disclosed staff had closed the door, but was unaware a child ran in to the classroom. UIR stated another staff in a adjacent classroom heard the child and noticed they were alone in their classroom. Facility management was made aware of incident after it occurred.

On 03/15/2023, LPAs Caywood and Giese made contact with facility/director and staff associated with events disclosed on UIR. LPAs reviewed documents and conducted interviews with pertinent parties. LPAs recorded corroborating statements from all individuals interviewed which support events reported on the UIR. Staff was transitioning children from the playground and was unaware that one child ran back into their classroom while they were redirecting two children that had ran back to the playground area. Another Staff was assisting their children with toileting when they heard a child call out to them from the adjacent classroom. Staff observed a child alone in the adjacent classroom and stated they were unaware of the length of time the child was unattended.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2023
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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334812757
VISIT DATE: 03/15/2023
NARRATIVE
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Based on observations, records reviewed, and interviews conducted. The facility was found to be in violation for the following Title 22 regulation: Responsibility for providing care and supervision. This poses an immediate health and safety risk for children in care.
See LIC809D for Type A Deficiency

A Civil Penalty of $500 will be assessed during this investigation for Responsibility for Providing Care and Supervision. 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.

Additionally, based on the observations, records review and interviews conducted during this visit LPAs discovered that the facility had knowledge of this UIR on 02/15/2023 and failed to report it to licensing in an adequate time frame. The UIR was not reported to Licensing until 02/24/2023, nine days after occurrence. The facility was found to be in violation of the following Title 22 regulations: Reporting requirements: this is a potential risk to the health and safety of children in care.
See LIC809D for Type B Deficiency.


An exit interview was conducted, and LPA provided the Director with a copy of this report

LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Director understands that the Notice of Site Visit must remain posted for the next 30 days along with a copy of all Type A deficiencies cited during this inspection. A copy of all Type A deficiencies cited during this inspection must also be immediately (within 24 hours of child’s next day in care) given to the parents of all children enrolled in the child care facility and any children enrolled into the child care facility over the next 12 months (at the time of enrollment). Director is required to have all parents sign and date the Acknowledgement of Receipt of Licensing Reports (LIC9224) and maintain a copy in each child’s file. A copy of this report, LIC9224 and Appeal Rights (LIC9058) were provided during this inspection.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 03/15/2023 04:36 PM - It Cannot Be Edited


Created By: Claudia Caywood On 03/15/2023 at 02:35 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: 334812757

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/16/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision - No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement has not been met as evidenced by:
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IMMEDIATE CIVIL PENALTY OF $500 WILL BE ASSESSED
Facility Director understands the importance of providing care and supervision for children in care at all time. Facility director will conduct a training session with staff and submit the outline
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Based on Interviews and records reviewed, on 02/15/2023 a child was without supervision and alone in a classroom while S1 was transitioning children from the playground. This poses an immediate health and safety risk to the children in care.
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of topics discussed regarding maintaining visual observation of children at all times. Documentation of training/proof of correction will need to be submitted to LPA on or before the date of correction, 03/16/2023.

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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:Gilbert Sena
LICENSING EVALUATOR NAME:Claudia Caywood
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/15/2023 04:36 PM - It Cannot Be Edited


Created By: Claudia Caywood On 03/15/2023 at 02:54 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: 334812757

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2023
Section Cited
CCR
101212(d)

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Reporting Requirements – (d) Upon the occurence...a report shall be made to the Department by telephone or fax within the Department's next working day...a written report...shall be submitted...within seven days following the occurrence...
This was not met as evidenced by:
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Facility Director understands the importance of reporting requirements. Facility Director will conduct training with staff and members of management on the proper time frame incident reports must be reported to licensing.
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Based on records reviewed, the incident occurred on 02/15/2023 and was not reported to licensing until 02/24/2023, nine days after occurrence.

This poses a potential risk to the health and safety of children in care.
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 Documentation of training/proof of correction will need to be submitted to LPA on or before the date of correction, 03/22/2023

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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:Gilbert Sena
LICENSING EVALUATOR NAME:Claudia Caywood
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023


LIC809 (FAS) - (06/04)
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