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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818107
Report Date: 10/25/2022
Date Signed: 10/31/2022 12:15:22 PM


Document Has Been Signed on 10/31/2022 12:15 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:
364818107
ADMINISTRATOR:EMILY CALHOUNFACILITY TYPE:
850
ADDRESS:33788 YUCAIPA BLVD.TELEPHONE:
(909) 797-4713
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:64CENSUS: 61DATE:
10/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Assistant Director, Ruth DeAndaTIME COMPLETED:
07:00 PM
NARRATIVE
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On 10/25/2022, Licensing Program Analysts (LPAs) Destinee Hogue and Aman Sharma arrived at the facility to conduct a case management inspection. A case management inspection is being conducted in response to the receipt of an unusual incident report (UIR). The UIR was received by the licensing agency on 10/18/2022. During this inspection, LPAs toured the facility (including the location where the incident took place), gathered evidence including additional documents. Census of children present was taken on this date, along with facility associations. LPAs discussed the following with Assistant Director, Ruth DeAnda:

The facility reported, on or about Monday, October 17, 2022, a child(ren) was found alone in a preschool classroom (Llamas classroom). According to the reported information, the classroom was transitioning to outdoor activity time, when a child(ren) got out of line and returned to the classroom unattended.

According to interview disclosures, a staff member(s) was walking in the hallway to relieve a staff member(s) from another class and observed the child(ren) alone in the classroom. The staff member(s) retrieved the child(ren) and returned the child(ren) to their assigned classroom on the playground. According to interviews, the child(ren) was left alone in the Llama classroom for approximately one to two minutes and the supervising staff member(s) did not have knowledge the child(ren) had returned to the classroom unsupervised.

Based on information gathered, there appears to be a violation of Title 22 Regulations found at this time. SEE LIC809D for cited deficiencies.


A Civil Penalty has been assessed during this inspection. Payment is due when billed and the check(s) or money orders shall be made payable to the “California Department of Social Services”. YOU WILL RECEIVE AN INVOICE IN THE MAIL. DO NOT SEND MONEY UNTIL YOU RECEIVE YOUR INVOICE. DO NOT SEND CASH.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
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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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: 364818107
VISIT DATE: 10/25/2022
NARRATIVE
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LPAs Destinee Hogue and Aman Sharma informed Assistant Director, Ruth DeAnda that this report dated 10/25/2022 document(s) one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPAs Hogue and Sharma informed Assistant Director, Ruth DeAnda to provide a copy of this licensing report dated 10/25/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Assistant Director, Ruth DeAnda.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 10/31/2022 12:15 PM - 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: 364818107

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/26/2022
Section Cited

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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,...Supervision shall include visual observation.

This requirement was not met as evidenced by:
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Based on interviews and reported information, a child(ren) was found in the Llama Classroom unsupervised. According to interviews, the child(ren) was in the classroom unsupervised for approximately one to two minutes. This poses an immediate health, safety, or personal rights risk to children in care.
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Child Supervision Record's. Assistant Director agrees to submit staff meeting and training agenda along with staff meeting attendance sheet.

A CIVIL PENALTY WAS ASSESSED DURING THIS INSPECTION.

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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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
LIC809 (FAS) - (06/04)
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