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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343607712
Report Date: 02/25/2022
Date Signed: 02/25/2022 02:56:54 PM

Document Has Been Signed on 02/25/2022 02:56 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:KINDERCARE LEARNING CENTER - NATOMA (PRESCHOOL)FACILITY NUMBER:
343607712
ADMINISTRATOR:MALHI, PARVEENFACILITY TYPE:
850
ADDRESS:420 NATOMA STATION DR.TELEPHONE:
(916) 353-0687
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY: 70TOTAL ENROLLED CHILDREN: 70CENSUS: 39DATE:
02/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Jeanie YangTIME COMPLETED:
03:15 PM
NARRATIVE
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On February 25th, 2022, Licensing Program Analysts (LPAs) Kelly Ferrara and Arianna Manabat conducted a Case Management Inspection and met with Assistant Director Jeanie Yang. Today's census included 39 preschool children in care with five staff.

LPA Ferrara received an Unusual Incident Report from the facility regarding an incident that occurred on February 18th, 2022. During today's inspection, LPAs interviewed staff involved with the incident and the Assistant Director. LPAs learned that Child #1 was left unattended outside for approximately 15 to 20 minutes while the children were transitioning from outside play time to inside the classroom. Child #1 was found hiding under the play structure outside. Staff stated that there were multiple changes occurring between the staff switching classrooms and moving children around during that time. Assistant Director stated that the staff involved were trained on using the classroom count sheets, doing name to face during a transition, and checking the play structures before coming inside.

Based on the information received, a violation of Title 22 regulations has occurred. Exit interview was conducted and a copy of this report was given to the Director. Notice of site was given and must remain posted for 30 days.

One Type A deficiency was cited on the attached LIC 809D and a civil penalty was assessed regarding an absence of supervision. Upon receipt of a Type A citation, licensee shall post and provide copies of the LIC 809 D for parents/guardians of children in care and for parents/guardians of newly enrolled children for the next 12 months. Licensee must also keep the signed LIC 9224, acknowledging receipt of LIC 809 D in each child's file.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Kelly Ferrara
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2022
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 02/25/2022 02:56 PM - It Cannot Be Edited


Created By: Kelly Ferrara On 02/25/2022 at 12:35 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
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: KINDERCARE LEARNING CENTER - NATOMA (PRESCHOOL)
FACILITY NUMBER: 343607712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2022
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time…Supervision shall include visual observation.
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Assistant Director shall submit documentation of their procedure for name to face during a transition. Assistant Director shall submit staff sign in sheet for the recent training received. The documentation will be submitted to LPA Ferrara by POC due date.
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This requirement was not met as evidenced by: A self-reported incident and statements made in interviews revealed that Child #1 was left unattended outside for 15 to 20 minutes without supervision. This is an immediate health and safety risk to children in care.
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Civil penalty in the amount of $500.00 is assessed for absence of supervision.

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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:Maria Mayorga
LICENSING EVALUATOR NAME:Kelly Ferrara
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2022


LIC809 (FAS) - (06/04)
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