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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603011
Report Date: 09/07/2023
Date Signed: 09/07/2023 04:07:17 PM


Document Has Been Signed on 09/07/2023 04:07 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:SCOVEL, BECCAFACILITY TYPE:
850
ADDRESS:9150 PEETS STREETTELEPHONE:
(916) 684-9284
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:72CENSUS: 42DATE:
09/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Amy MorenoTIME COMPLETED:
04:15 PM
NARRATIVE
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On 09/07/2023, 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 08/29/2023. LPA arrived at the facility and was met by Assistant Director Amy Moreno (D1). LPA disclosed the purpose of the inspection and was granted entrance. LPA toured the facility and observed 42 preschool aged children who were supervised by 3 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. Interviews corroborate what was reported in the UIR: a child was left asleep and unsupervised while the teacher and children transitioned to another classroom.This poses an immediate risk to the health and safety of children in care. As a result of the absence of supervision, 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 (under license #343603011) must sign the LIC 9224 form and be available to the Department for review. D1 understands that parents or authorized representatives of children enrolling (under license #343603011) 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 D1. 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.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy VelazquezTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 09/07/2023 04:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 - PEETS
FACILITY NUMBER: 343603011

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/08/2023
Section Cited
CCR
101229(a)(1)

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(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. This requirement was not met, as evidenced by:
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 D1 will have all staff members watch the CDSS videos "Teacher-to-Child Ratio..." and "Supervising Children in Child Care Centers." Staff will sign a statement aknowledging that they have watched the videos in entirety. D1 will email LPA the signed statements by 5 pm on 9/08/2023.
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Based on record review and interviews, the above regulation was not met, as a preschooler child was left alone and unsupervised for a period of 50 minutes on 08/29/2023. This poses an immediate risk to the health and safety of children in care. Civil penalties were assessed.
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D1 will have all staff members review the CSR policies for Face-to-name recognition and parent sign-in procedures. Staff will sign aknowledging that they have reviewed the policies. D1 will email LPA the signed statements by 5 pm on 9/08/2023.

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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 GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy VelazquezTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023
LIC809 (FAS) - (06/04)
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