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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334812757
Report Date: 05/04/2023
Date Signed: 05/04/2023 09:50:55 AM

Document Has Been Signed on 05/04/2023 09:50 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
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: DATE:
05/04/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jessica Salvador-RiveraTIME COMPLETED:
10:10 AM
NARRATIVE
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On 05/04/23, at 9:15 AM, Licensing Program Analyst (LPA) Claudia Caywood arrived at the facility to conduct a case management visit. During the visit, LPA toured the facility and took census.

The purpose of the visit was to deliver an amended report for a report issued on 04/11/23 and to address a deficiency, which was discovered during an investigation.

On 04/11/23, LPA discovered a child’s representative did not sign an admission agreement per Title 22, Code of Regulation, Section 101221 (b)(6). Director provided the LPA a copy of the admission agreement. Director stated the authorized representative completed the agreement online; however, did not sign prior to submitting to the facility and the facility did not ensure the authorized representative signed prior to accepting the agreement.

SEE LIC 809-D for the deficiencies cited.

An exit interview was conducted with Director, Jessica Salvador Rivera. A copy of this report and Notice of Site Visit form were provided. LPA verified the Director posted the Notice of Site Visit form. Director understands the Notice of Site Visit form must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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Document Has Been Signed on 05/04/2023 09:50 AM - It Cannot Be Edited


Created By: Claudia Caywood On 05/03/2023 at 12:56 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: 05/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/04/2023
Section Cited
CCR
101221(b)(6)

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101221 (b)(6) A signed copy of the admission agreement specified in Section 101219. This requirement is not met as evidenced by: Based on an unsigned admission agreement obtained by LPA. This poses a potential health and safety risk to children in care.
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Director agreed to review all signed admissions agreement upon enrollment to ensure all documents have been signed.

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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: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


LIC809 (FAS) - (06/04)
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