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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700316
Report Date: 10/31/2023
Date Signed: 10/31/2023 04:03:46 PM

Document Has Been Signed on 10/31/2023 04:03 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:KINDERCARE LEARNING CENTER - WORLD TRADEFACILITY NUMBER:
376700316
ADMINISTRATOR:RASHELLE CULTRERAFACILITY TYPE:
830
ADDRESS:12135 WORLD TRADE DRIVETELEPHONE:
(858) 487-6444
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 52TOTAL ENROLLED CHILDREN: 26CENSUS: 23DATE:
10/31/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Rashelle CultreraTIME COMPLETED:
04:15 PM
NARRATIVE
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On 10/31/2023 at 02:01pm, Licensing Program Analyst (LPA) Selina Siao made an unannounced case management inspection to follow up on an alleged personal rights incident that happened on 10/23/2023. The alleged incident was that a staff had pushed a child and also yelled at a child in care. The alleged concerned was reported to the Assistant Director and Director on that day. Facility representative did not report the alleged personal rights incident to the department.

LPA met with Director Rashelle Cultrera and conducted a tour of two infant classrooms and the following ratios were observed: Toddler Room A had 12 children, supervised by staff members Maryam Mosa, Denise Fickling, Leandra Mayorga and Cara Lackey. Infant Room had 11 children, supervised by staff members Sarah Doty, Tyra Hooper, and Darlena Van Den Bergh. Facility was within ratios during the tour.

Staff Maryam Mosa has the required background clearances but is not associated to the facility.


See LIC809D for type B citation issue.


SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Selina Siao
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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 10/31/2023 04:03 PM - It Cannot Be Edited


Created By: Selina Siao On 10/31/2023 at 01:19 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: 10/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/13/2023
Section Cited
CCR
101212(d)(1)(c)

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Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report ... shall be submitted to the Department within seven days following
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Director stated that she was not aware that she had to report the alleged personal rights incident to the department. Director stated that she will review the reporting requirement regulation with her staff members.
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the occurrence of such event. This requirement is not met as evidence by: On 10/23/2023, it was alleged that a staff had pushed a child and yelled at a child in care. Facility did not report the alleged incident to the department. This poses a potential health and safety risk to children in care.
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She will also review the unusual incident form with her staff. Director will submit the unusual incident form along with her new operation and records orientation certificate to Licensing no later than 11/13/2023.
Type B
11/13/2023
Section Cited
CCR101170(e)(2)

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Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f).
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Director submitted Maryam Mosa criminal background transfer request to the licensing office via email during the inspection. A copy of the facility's associated list was provided to the Director today.
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This requirement is not met as staff Maryam Mosa has been working at the facility since August of 2023 and her fingerprint is not associated to the facility and a fax confirmation receipt is not available for review. This poses a potential health and safety risk to children in care.
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Director stated that she will review the association list to ensure all staff members are associated prior to working. She will also have the fax confirmation receipt in the staff's file or proof of email send to licensing. Director will submit a written plan of correction to LPA no later than 11/06/2023.
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:Tashima Daniel
LICENSING EVALUATOR NAME:Selina Siao
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2023


LIC809 (FAS) - (06/04)
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