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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334812759
Report Date: 05/23/2023
Date Signed: 05/23/2023 11:51:16 AM

Document Has Been Signed on 05/23/2023 11:51 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:
334812759
ADMINISTRATOR:JESSICA SALVADOR-RIVERAFACILITY TYPE:
830
ADDRESS:1080 HIGHGROVETELEPHONE:
(951) 371-9346
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 116DATE:
05/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Jessica Salvador-RiveraTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Claudia Caywood 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 5/12/23. In the UIR it states Child #1 tried to stand up in his crib and fell out of the crib. Staff were present in the classroom when the child fell. Staff quickly recovered the child from the floor and applied an ice pack to the child’s head and the authorized representative were called. The child sustained a bump to the head as a result of the fall.

At the time of the inspection, LPA toured the facility, took census, and met with Director, Jessica Salvador-Rivera. 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:

101439 Infant Care Center Fixtures, Furniture, Equipment, and Supplies


(g) Furniture shall be maintained in good repair and safe condition.

See Lic. 809D for cited deficiencies of the California Code of Regulation, Title 22, Div. 12
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2023
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 05/23/2023 11:51 AM - It Cannot Be Edited


Created By: Claudia Caywood On 05/23/2023 at 11:23 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: 05/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2023
Section Cited
CCR
101439(g)

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Infant Care Center Fixtures, Furniture, Equipment, and Supplies.
(g) Furniture shall be maintained in good repair and safe condition.This requirement was not met as evidenced by: A child falling out of a crib and sustained a bump on his head. The Licensee did not meet the Infant Care Center Fixtures, Furniture, Equipment, and Supplies regulation which is a violation of the Title 22 regulation.
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Director agreed to have maintenace inspect all 16 crib gates at the facility

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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: 05/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2023


LIC809 (FAS) - (06/04)
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