<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809072
Report Date: 11/01/2024
Date Signed: 11/01/2024 05:00:35 PM

Document Has Been Signed on 11/01/2024 05:00 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
364809072
ADMINISTRATOR/
DIRECTOR:		SABRINA KATZFACILITY TYPE:
850
ADDRESS:16149 FOOTHILL BOULEVARDTELEPHONE:
(909) 823-2323
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 30DATE:
11/01/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:30 PM
MET WITH:Sabrina Katz, DirectorTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On the date and time listed above a case management visit was completed by Licensing Program Analysts (LPAs) Aman Lama and Giselle Carbullido due to deficiencies found during the course of another inspection.
101229.1(a)(1) Sign in and Sign Out: Facility did not implement procedures for sign in and out resulting in no authorized representative signatures on 11/01/2024.
See LIC 809D for the deficiency cited.
The facility representative was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.
An exit interview was conducted, a copy of this report and Notice of Site Visit were provided to the Facility representative Sabrina Katz. LPAs observed the Notice of Site Visit form was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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 11/01/2024 05:00 PM - It Cannot Be Edited


Created By: Giselle Carbullido On 11/01/2024 at 04:12 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364809072

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited
CCR
101229.1(a)(1)

1
2
3
4
5
6
7
101229.1(a)(1) -Sign In and Sign Out
(1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
This requirement is not met as evidenced by:

1
2
3
4
5
6
7
Facility will submit proof of completion of sign in and out procedures from 11/01/24- 11/07/24 by POC due date.
8
9
10
11
12
13
14
Based on director interview and record review, facility did not have sign in/out sheets available for authorized representatives on 11/01/24 resulting in no signatures for sign in. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Gilbert Sena
LICENSING EVALUATOR NAME:Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


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