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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343615336
Report Date: 06/27/2023
Date Signed: 06/27/2023 12:56:16 PM

Document Has Been Signed on 06/27/2023 12:56 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KINDERCARE LEARNING CENTER - ELK GROVE FLORINFACILITY NUMBER:
343615336
ADMINISTRATOR:CHAVEZ, ANGELAFACILITY TYPE:
840
ADDRESS:9250 ELK GROVE-FLORIN ROADTELEPHONE:
(916) 714-2772
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 26TOTAL ENROLLED CHILDREN: 26CENSUS: 5DATE:
06/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Suzana CervantezTIME COMPLETED:
01:30 PM
NARRATIVE
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On 06/27/2023, Licensing Program Analyst Jennie Tedlos (LPA1) and Licensing Program Analyst Katy Maestas (LPA2) conducted a field visit to the facility for the purpose of a case management inspection to follow up on a self reported Unusual Incident Report (UIR). LPAs arrived at the facility and disclosed the purpose of the inspection and were granted entrance. LPAs met with Suzana Cervantez (AD).

Based on record reviews and LPA observations, the facility is being cited one Type A deficiency on a subsequent 809-D page. As a result of the deficiencies, AD understands that LIC 9224 must be signed by all current authorized representatives and potential authorized representatives for up to one year. The LIC 9224 must be kept in each child's file for the Department's review.

An exit interview was conducted, and the report was reviewed with AD. LPA provided AD with Licensee Appeal Rights. A notice of site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2023
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 06/27/2023 12:56 PM - It Cannot Be Edited


Created By: Jennie Tedlos On 06/27/2023 at 12:39 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 - ELK GROVE FLORIN
FACILITY NUMBER: 343615336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2023
Section Cited
CCR
101229(a)

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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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).
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Acting Director (AD) will create a bus unloading supervision policy for both 1 and 2 staff members ; including unloading to the sidewalk. Staff members who transport children will sign a copy of the policy and be kept in their personnel file. AD will email LPA the policy by 6/28/23.
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 Supervision shall include visual observation.
This requirement was not met as evidenced by: LPA observed improper supervision displayed on 6/22/23 during the unloading of children off a bus. Teacher left the bus and entered the facility without supervising the children being released off the bus.
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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:Bettina Engelman
LICENSING EVALUATOR NAME:Jennie Tedlos
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023


LIC809 (FAS) - (06/04)
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