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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364809073
Report Date: 11/01/2024
Date Signed: 11/01/2024 04:53:29 PM

Document Has Been Signed on 11/01/2024 04:53 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:
364809073
ADMINISTRATOR/
DIRECTOR:		SABRINA KATZFACILITY TYPE:
840
ADDRESS:16149 FOOTHILL BOULEVARDTELEPHONE:
(909) 823-2323
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: 19DATE:
11/01/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Sabrina KatzTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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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 representatives signatures on 11/01/2024.

SEE LIC809D for cited deficiencies.

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 was provided to the facility representative, Sabrina Katz. LPAs observed the Notice of Site Visit was posted by staff.

THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THE NEXT THREE YEARS.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
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)
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Document Has Been Signed on 11/01/2024 04:53 PM - It Cannot Be Edited


Created By: Aman Lama On 11/01/2024 at 04:02 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: 364809073

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/07/2024
Section Cited
CCR
101229.1(a)(1)

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(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the center that shall, at a minimum, include the following:(1) The person who signs the child in/out shall use
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Facility will submit proof of completion of sign in/out procedures for 11/01/24-11/07/24
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his/her full legal signature and shall record the time of day. Based on director interview &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
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health and safety risk for 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:Gilbert Sena
LICENSING EVALUATOR NAME:Aman Lama
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)
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