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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393603299
Report Date: 08/15/2023
Date Signed: 08/15/2023 02:36:19 PM

Document Has Been Signed on 08/15/2023 02:36 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:KINDERCARE LEARNING CENTER - GRANTLINEFACILITY NUMBER:
393603299
ADMINISTRATOR:EVA PRADOFACILITY TYPE:
850
ADDRESS:265 WEST GRANT LINE ROADTELEPHONE:
(209) 835-9247
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 65DATE:
08/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:42 PM
MET WITH:Eva PradoTIME COMPLETED:
02:45 PM
NARRATIVE
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On August 15, 2023, Licensing Program Analyst (LPA) Stacey Williams met with Director, Eva Prado for a case management inspection as a result of receiving an unusual incident report. LPA observed (65) sixty five preschool students (napping) supervised by four staff.

On 08/8/23 an incident occurred, where it was reported that a child was left unattended on the play yard of the facility. The child was found by a teacher at the facility and returned to their classroom. Facility estimates the child was left unsupervised for approximately three minutes. Immediately following the incident, management staff met with all preschool teachers to review protocol for face to name recognition while conducting classroom headcounts. Per Director, training staff on topics of transition and supervision will be conducted on a one-on-one basis for every teacher with management staff.

Title 22 Deficiencies have been cited on the attached LIC 8099D. Upon receipt of Type A citations, facility shall post and provide copies of the LIC 809D for parents/guardians of children currently in care and for parents/guardians of newly enrolled children for the next 12 months. Facility must also keep the signed LIC 9224, Acknowledging Receipt of Licensing Reports LIC 809D in each child's files.

Exit interview conducted at which time the report was reviewed with Facility Representative, Eva Prado. A Notice of Site Visit was posted by LPA Williams and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.00.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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 08/15/2023 02:36 PM - It Cannot Be Edited


Created By: Stacey Williams On 08/15/2023 at 02:14 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: KINDERCARE LEARNING CENTER - GRANTLINE
FACILITY NUMBER: 393603299

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/16/2023
Section Cited
HSC
1596.99(c)(3)(c)

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1596.99(c)(3) (c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues .... :(3) Absence of supervision, including, but not limited to, a child left unattended, and supervision of a child by a person under 18 years of age.
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Director stated that protocol for supervision and name to face headcount was reviewed with each staff after the incident. Staff signed a document acknowledging the review. Staff will also be trained one on one for the review of supervision and head counting during transitions.
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This requirement was not met as evidence by: Community Care Licensing was notified of an incident from facility staff and by unusual incident report that on 8/8/23, C1 was left unattended on the play yard of the facility for approximately three minutes. This poses an immediate risk to the health and safety of children in care.
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Director stated that management will be involved during all classroom transitions going forward. Director shall submit training documentation by POC date- 8/16/23. Civil Penalty of five hunded follars($500.00) will be assess on the next page (LIC 421M)

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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:Bettina Engelman
LICENSING EVALUATOR NAME:Stacey Williams
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2023


LIC809 (FAS) - (06/04)
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