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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364812754
Report Date: 01/11/2024
Date Signed: 01/11/2024 10:10:47 AM


Document Has Been Signed on 01/11/2024 10:10 AM - 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:
364812754
ADMINISTRATOR:ASHLEY RAWLSFACILITY TYPE:
850
ADDRESS:11249 BASELINE AVENUETELEPHONE:
(909) 581-0944
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:100CENSUS: 78DATE:
01/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Ashley Rawls/directorTIME COMPLETED:
10:30 AM
NARRATIVE
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On 1/11/24 at 8:00 am, Licensing Program Analyst conducted a case management incident investigation. LPA met with director and was granted access into the facility. LPA toured facility and took a census.

On 1/2/24 Regional Office received an Unusual Incident Report (UIR) that occurred on 12/21/23. It was reported a staff member handled a child inappropriately. LPA conducted interviews with all pertinent parties. Pertinent parties stated there was a incident with a staff who did grab a child by the wrist to remove the child from pushing another child. Pertinent parties stated the staff member was trying to protect the child being pushed; however the staff member did not handle the child in an appropriate manner. Pertinent parties stated no injury occurred to either child. Based on information received the staff member did inappropriately handle the child and therefore there is a potential health and safety risk and a personal rights violation of Title 22 regulations. The facility did report the incident in a timely manner to Community Care Licensing.

See 809D for deficiency.

Exit interview conducted with director, report, appeal rights and notice of site visit issued.

Notice of site visit must be posted for 30 days.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024
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 01/11/2024 10:10 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364812754

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2024
Section Cited
CCR
101223(a)(3)

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Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from... unusual punishment, infliction of pain, humiliation, intimidation, ridicule ...
This requirement was not met as evidenced by
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Director stated all staff will be retained on personal rights, and staff member will mentor with another staff member. Director stated she will send the topic and a list of participants to the CCL by 1/18/24.
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Based on pertinent parties interviews a staff member did not appropriately handle a child.

This is a potential health and safety and personal rights of 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 SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024
LIC809 (FAS) - (06/04)
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