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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700316
Report Date: 11/02/2022
Date Signed: 11/02/2022 04:23:23 PM

Document Has Been Signed on 11/02/2022 04:23 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:KINDERCARE LEARNING CENTER - WORLD TRADEFACILITY NUMBER:
376700316
ADMINISTRATOR:MCKENZIE EATCHELFACILITY TYPE:
830
ADDRESS:12135 WORLD TRADE DRIVETELEPHONE:
(858) 487-6444
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 52TOTAL ENROLLED CHILDREN: 28CENSUS: 26DATE:
11/02/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:42 PM
MET WITH:Emily Wolford-Assistant Director TIME COMPLETED:
04:30 PM
NARRATIVE
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On 11/02/2022 at 3:42pm, Licensing Program Analyst, (LPA), Selina Siao conducted a case management inspection to follow with a self reported incident that occurred on 10/19/2022 in the infant room. Upon arrival, LPA met with Assistant Director Emily Wolford and conducted a tour of the classrooms to gather census. LPA Siao observed 26 daycare infants with 6 staff members. Facility was within ratio & capacity.

On 10/19/2022, staff #1 put a bottle in the warmer and went on a lunch break when staff #2 came in to break her for lunch. Staff #1 informed the staff members the two infants that needed their bottles at the same time at 11:15am. Staff #3 took the bottle from the warmer and mistakenly feed infant #1 the bottle of breast milk that is labeled and belongs to infant #2. Both infants #1 and #2 had been due for a bottle at the same time at 11:15am. When staff #2 was about to change a child's diaper, staff #3 insist to switch task. Therefore staff #2 got the bottle from staff #3 to feed infant #1 and realized they had feed infant #1 the wrong bottle. Both of the infants parents were informed about the incident. Both staff members involved received written documentation for not following the bottle policy.

Per the staff members and Director, child #1 did not sustain any allergic reaction to the wrong bottle of breast milk. LPA Siao inspected the feeding bottles and food items during today's visit. The bottles and food items are properly labeled with the child's name and the date during today's visit. All infant teachers and support staff were retrained on KinderCare's bottle policy which requires name to face check before placing the bottle in the warmer and again before feeding baby with with verification from a second teacher.

See LIC809D for type B deficiency cited. Notice of site visit was posted and must remain posted for 30 days.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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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Document Has Been Signed on 11/02/2022 04:23 PM - It Cannot Be Edited


Created By: Selina Siao On 11/02/2022 at 02:49 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: KINDERCARE LEARNING CENTER - WORLD TRADE
FACILITY NUMBER: 376700316

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/03/2022
Section Cited
CCR
101216(a)

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Personnel Requirements
Child care center personnel shall be competent to provide the services necessary to meet the individual needs of children in care and shall at all times be employed in numbers sufficient to meet those needs.
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Director conducted training with all of the infant teachers and support teachers regarding the name to face check before placing the bottle in the warmer and before feeding the baby with verification from a second
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This requirement was not met when Staff #2 and #3 fed the wrong bottle of milk to infant #1 because they did not verify the bottle information prior to feeding. Infant#1 did not sustain any allergic reaction to the wrong bottle of breast milk. This is a potential hazard to children in care if not corrected.
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teacher per KinderCare's bottle policy. Director submitted the staff's members training agendas with all the staff's names and signatures of the training provided to them.

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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:Monica Cuddy
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2022


LIC809 (FAS) - (06/04)
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