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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603011
Report Date: 10/21/2024
Date Signed: 10/21/2024 03:03:13 PM

Document Has Been Signed on 10/21/2024 03:03 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KINDERCARE LEARNING CENTER - PEETSFACILITY NUMBER:
343603011
ADMINISTRATOR/
DIRECTOR:		MORENO, AMYFACILITY TYPE:
850
ADDRESS:9150 PEETS STREETTELEPHONE:
(916) 684-9284
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 48DATE:
10/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Amy MorenoTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 10/21/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a Case Management inspection regarding a self reported Unusual Incident Report (UIR) dated 10/11/2024. LPA arrived at the facility and was met by Director Amy Moreno (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed 48 preschool aged children being supervised by 5 staff members during nap time. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

LPA conducted staff interviews and collected documentation. Interviews and documentation reveal that a child was unsupervised for an undetermined amount of time and found alone in a classroom by a Speech Therapist. This absence of supervision poses an immediate risk to the health and safety of children in care. As a result, a Type-A deficiency was cited on a subsequent 809-D page with a Civil Penalty. D1 understands that all parents or authorized representatives of currently enrolled children must sign the LIC 9224 form and be available to the Department for review. D1 understands that parents or authorized representatives of children enrolling for up to one year must sign the LIC 9224 form and be available to the Department for review. D1 acknowledged that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 809-D with Type A deficiencies for 30 days.

An exit interview was conducted, and the report was reviewed with Director Moreno. LPA provided D1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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 10/21/2024 03:03 PM - It Cannot Be Edited


Created By: Katy Velazquez On 10/21/2024 at 02:27 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 - PEETS
FACILITY NUMBER: 343603011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/22/2024
Section Cited
CCR
101229(a)(1)

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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, ...Supervision shall include visual observation.
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Director Moreno installed 2 baby-gates on 10/12/2024; 1 gate at each exit door of the classroom. Staff received training on 10/14/2024 regarding supervision. LPA cleared the citation during the field visit.
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This requirement was not met as evidenced by a child being found alone & unsupervised in a classroom on 10/11/2024.
This absence of supervision poses/posed an immediate health, safety or personal rights risk to persons in care.
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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:Karyn Guerra
LICENSING EVALUATOR NAME:Katy Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2024


LIC809 (FAS) - (06/04)
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