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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809072
Report Date: 12/02/2021
Date Signed: 12/02/2021 02:50:40 PM

Document Has Been Signed on 12/02/2021 02:50 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
364809072
ADMINISTRATOR:MORALES, ASHLEYFACILITY TYPE:
850
ADDRESS:16149 FOOTHILL BOULEVARDTELEPHONE:
(909) 823-2323
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 22DATE:
12/02/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Jessica Salvador-Rivera/DirectorTIME COMPLETED:
03:14 PM
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On 12/2/2021 at 1:50 pm, Licensing Program Analyst (LPA) Patricia Berry conducted subsequent a case management incident investigation to conclude investigation. LPA was granted access into the facility and met with director. LPA took a census.


Regarding an Unusual Incident Report, self reported by director to Community Care Licensing on 11/11/2021 director stated on 11/11/2021 a strong wind swept through the playground of the facility. Director stated when the wind started blowing the children were trying to close the door behind them. Director stated the staff member noticed as the child and other children were closing the door, the door had closed on the child’s hand. Staff member immediately called the director they applied ice and called the parent. Director stated the parent took child to Urgent Care where the child received a soft cast for protection. Director stated the parent informed her there were no broken or fractured bones, this was also confirmed from interview with parent. LPA interviewed the child and child confirmed the door closed on child's hand due to the wind and the teacher was at the door with the child..


Based on information obtained teacher was supervising children when the incident occurred, child interview stated the door closed on child's hand due to the wind, LPA has determined at this time there has been no violation of Title 22 regulations.


Exit interview with director, report, appeal rights and Notice of Site Visit provided to director.

LPA observed director post notice.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2021
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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