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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603013
Report Date: 02/11/2025
Date Signed: 02/11/2025 02:51:05 PM

Document Has Been Signed on 02/11/2025 02:51 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:
343603013
ADMINISTRATOR/
DIRECTOR:		MORENO, AMYFACILITY TYPE:
840
ADDRESS:9150 PEETS STREETTELEPHONE:
(916) 684-9284
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 13DATE:
02/11/2025
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 02/11/2025, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection. LPA arrived at the center and was met by Director Amy Moreno (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA conducted a tour of the facility and observed 13 school aged children being supervised by 1 staff member. LPA determined, through accessing Guardian, that required adults had background clearances on file. LPA reminded D1 to ensure that employees are associated to each license that s/he works under.

The facility self reported a lack of supervision on 02/07/2025. A child was left alone in the administration office for approximately 3-5 minutes. LPA collected documentation and conducted staff interviews. As a result of the lack of supervision, a Type-A deficiency was cited on a subsequent 9099-D page. D1 acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee.

An exit interview was conducted, and the report was reviewed with Director Moreno. LPA provided Licensee Appeal Rights to D1. 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: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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 02/11/2025 02:51 PM - It Cannot Be Edited


Created By: Katy Velazquez On 02/11/2025 at 02:29 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: 343603013

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/12/2025
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 conducted supervision training with T1 on 02/07/2025. LPA cleared the citation while on site.
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This requirement was not met as evidenced by C1 being left alone in the office on 02/07/2025; this 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: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


LIC809 (FAS) - (06/04)
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