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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343602983
Report Date: 10/08/2024
Date Signed: 10/08/2024 02:43:20 PM

Document Has Been Signed on 10/08/2024 02:43 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KINDERCARE LEARNING CENTER - VEHICLE (PS)FACILITY NUMBER:
343602983
ADMINISTRATOR/
DIRECTOR:		CARRIE ROBINSONFACILITY TYPE:
850
ADDRESS:2329 VEHICLE DRIVETELEPHONE:
(916) 635-5700
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95670
CAPACITY: 92TOTAL ENROLLED CHILDREN: 92CENSUS: 40DATE:
10/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Carrie RobinsonTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Erwina Pascual-Golamco, met with Director, Carrie Robinson, for a case management inspection regarding an incident on 10/04/24. Purpose of the inspection was explained.

Director self reported and submitted a written Unusual Incident Report LIC624, that on 10/04/24, staff left a child unattended in the play yard at around 10:55AM. According to Director, staff and children were in transition from playground to inside, staff used their Child Supervision Record (CSR) form, did their name to face, and staff saw child come in when called. Sometime between transition, child went back out to the playground, and another staff member found the child on the play structure without supervision at around 10:56AM, leaving the child unattended for approximately 1 minute according to the UIR. Staff members informed Director about the incident, and Director self reported the incident to the department, investigated, interviewed staff and witnesses, informed parent/guardian of child and took necessary steps/actions needed for KinderCare.

Based on interview and record reviews, Title 22 Deficiency has been issued on the attached LIC809-D page. Director was informed that the Type A deficiency cited today is an immediate civil penalty, for absence of supervision, and is being assessed in the amount of $500. Director shall also provide a copy of this licensing report to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. Exit interview was conducted with Director, appeal rights were provided, and A notice of site visit was given Director, who will post it where visible to parents/guardians for 30 days. A signed Acknowledgement of Receipt of the Licensing Report (LIC9224) must be placed in the child's file for verification.
SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE: DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/08/2024
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 10/08/2024 02:43 PM - It Cannot Be Edited


Created By: Erwina Pascual-Golamco On 10/08/2024 at 01:54 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KINDERCARE LEARNING CENTER - VEHICLE (PS)
FACILITY NUMBER: 343602983

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/09/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...shall include visual observation.
This requirement is not met as evidenced by:
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Director stated staff will go through individual and group trainings on meaningful transitions, and Director will observe staff with transitions in the next few weeks. Director will email LPA by POC due date detailed plan of correction, and Director will provide documentation of trainings and observations by 10/22/24.
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Based on interview, and record reviews, Director (D) did not comply with the section cited above as a child was left in the playground without supervision of staff for approximately 1 minute, which poses an immediate health, safety, or personal rights risk to persons in care. Director self reported and submitted a written Unusual Incident Report (UIR) to the department.
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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:Natalie Dunaway
LICENSING EVALUATOR NAME:Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024


LIC809 (FAS) - (06/04)
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