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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343603018
Report Date: 09/19/2024
Date Signed: 09/19/2024 11:39:29 AM

Document Has Been Signed on 09/19/2024 11:39 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KINDERCARE LEARNING CENTER - MACK (INF)FACILITY NUMBER:
343603018
ADMINISTRATOR/
DIRECTOR:		DANA MATTHEWSFACILITY TYPE:
830
ADDRESS:4920 MACK ROADTELEPHONE:
(916) 428-1880
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 21DATE:
09/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Dana MatthewsTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Gagandeep Singh met with the facility director, Dana Matthews, for a case management inspection. The facility self reported that a staff member was accused of using inappropriate form of discipline to a child.

During today’s inspection, LPA interviewed the director about the incident. Director stated that after being informed about the allegation, the facility conducted an internal investigation and interviewed the accused staff. Per director, the accused staff acknowledged the allegation and confessed. Per director, the staff is no longer working at this facility and the facility conducted the training for all staff about proper discipline forms and personal rights.

See next page for deficiency cited today. Copy of this report was reviewed and provided to the Director. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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 09/19/2024 11:39 AM - It Cannot Be Edited


Created By: Gagandeep Singh On 09/19/2024 at 11:17 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KINDERCARE LEARNING CENTER - MACK (INF)
FACILITY NUMBER: 343603018

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/04/2024
Section Cited
CCR
101223(a)(3)

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Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including
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Per director, the accused staff is no longer working at the facility. Facility has conducted the training for all staff about acceptable forms of discipline and personal rights of children.
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but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidenced by facility investigation, it was found that a staff used inappropriate form of discipline toward a child. This poses a potential Health and Safety risk to children 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:Natalie Dunaway
LICENSING EVALUATOR NAME:Gagandeep Singh
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2024


LIC809 (FAS) - (06/04)
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