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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334812759
Report Date: 09/22/2022
Date Signed: 09/22/2022 10:36:20 AM

Document Has Been Signed on 09/22/2022 10:36 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:
334812759
ADMINISTRATOR:MELINDA GASKINFACILITY TYPE:
830
ADDRESS:1080 HIGHGROVETELEPHONE:
(951) 371-9346
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 27DATE:
09/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Melinda Gaskin, DirectorTIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Elyse Jones arrived at the facility to conduct a
Case Management inspection in response to the receipt of an Unusual Incident Report (UIR) from the facility. The UIR was received by the licensing agency on 9/6/2022. In the UIR it states Child #1 was inadvertently given Child #2's bottle. Children's bottles were labeled and dated. No allergic reactions were noted. Director provided staff training which included handling, labeling and storing bottles.

At the time of the inspection, LPA toured the facility, took census, and met with Director, Melinda Gaskin. Additional interviews with pertinent parties were conducted to obtain details regarding the reported incident.

Based on the information gathered, the following violation has been identified:

101427 Infant Care Food Service


(c) The infant shall be fed in accordance with the individual plan.

See Lic 809D for cited deficiencies of the California Code of Regulation, Title 22, Div. 12

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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Document Has Been Signed on 09/22/2022 10:36 AM - It Cannot Be Edited


Created By: Elyse Jones On 09/22/2022 at 09:08 AM
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: 334812759

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2022
Section Cited
CCR
101427(c)

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Infant Care Food Service
(c) The infant shall be fed in accordance with the individual plan.
This requirement was not met as evidenced by:
Based on the interviews and record review, the Licensee did not meet Infant Care Food Service regulation which poses a potential
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During the inspection the Director provided a Staff Meeting Agenda with topics discussed during training on 9-12-2022.

Deficiencies cleared during inspection.
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Health, Safety & Personal Rights risk to the children in care. During record review the facility self-reported that Child # 1 was given Child # 2’s bottle. Pertinent parties confirmed this to be true during interviews. Per Child #1’s Infant and Toddler Schedule he/she should have been given Similac but was given an Enfamil.
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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:Aaron Ross
LICENSING EVALUATOR NAME:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 09/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/22/2022


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: 334812759
VISIT DATE: 09/22/2022
NARRATIVE
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An exit interview was conducted, appealed rights discussed, Notice of Site Visit and a copy of this report was provided to facility Director, Melinda Gaskin.

A copy of this report must be made available to the public at the facility site, for 3 years.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022
LIC809 (FAS) - (06/04)
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