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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001833
Report Date: 06/30/2021
Date Signed: 06/30/2021 02:56:27 PM

Document Has Been Signed on 06/30/2021 02:56 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001833
ADMINISTRATOR:WENDY CERTEZAFACILITY TYPE:
840
ADDRESS:1611 WOOD CREEK DRIVETELEPHONE:
(707) 426-2275
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 50TOTAL ENROLLED CHILDREN: 0CENSUS: 19DATE:
06/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Wendy CertezaTIME COMPLETED:
03:15 PM
NARRATIVE
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A required inspection was made to the facility by Licensing Program Analysts (LPAs), Elpidia Hernandez Torres and Melchisedeck Augustin. The facility file was reviewed prior to this inspection. A review of the personnel report on 06/30/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility’s operating hours are 06:30AM- 06:00PM, Monday – Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children. Center Director stated poisons are not stored on site. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces were clean, toxic free, safe and in good condition. Children have access to drinking water indoors and outdoors. Children have access to cups to obtain drinking water in a classroom sink. The children’s bathrooms were in safe and sanitary condition. A current menu was posted outside the classroom door. Food prep areas are clean. Food is properly stored and free of contamination. Garbage cans containing solid waste have tight fitting lids. The playground was free of hazards. The playground equipment and surface areas were in safe condition. There is a foam cushioning pad underneath climbing structures and play equipment to absorb falls. There were no bodies of water observed. The center director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and there were 19 children being supervised by two teachers and one aide. The facility was operating within the licensed capacity. The director’s CPR ,First Aid certification and AB 1207 Mandated reporter training certificate were expired. Two children’s ( C1 & C2) records were reviewed at 10:30 AM, and contained identification forms with authorized representative information, as well as medical assessments. Five staff (CD, AD, S1-S3) records were reviewed at 11:06AM, and contained health screening forms. S1, S2, S3, and AD were missing their required immunization record. S1-S3 were missing proof of negative TB. The sign in/out procedure was reviewed and two children were not signed in for multiple days. The Facility Roster with children in care was incomplete. This facility is not providing Incidental Medical Services (IMS) to children. The Department’s IMS policy was discussed with the Center Director. (Continue to LIC 809-C)
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2021
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 5
Document Has Been Signed on 06/30/2021 02:56 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 06/30/2021 at 01:08 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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001833

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2021
Section Cited
CCR
101616.3(f)

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At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be onsite at all times when children are present.
This requirement has not been met as evidenced by: Based on record review revealing that Center Director had expired...
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Center Director stated all personnel missing Pediatric CPR and First Aid will begin looking for EMSA approved open courses, and will submit proof of completion to the deparment by 07/30/2021
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. . .CPR and First Aid Certification and could not furnish Valid CPR and First Aid Certification. This poses a potential health and saftey risk to the children in care.
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Type B
07/19/2021
Section Cited
HSC1596.7995(a)(1)

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Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirment has not been met as
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Center Director stated "were going to get it all taking care of" and will submit proof of missing immunizations by 07/19/2021, If center can't meet the deadline, center director will contact LPA Herandez Torres to request an extension.
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evidenced by: based on staff records review conducted at 11:06AM, S1, S2, S3, and AD were missing their required immunization record. This poses a potential health and saftey risk to children in care.
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Elpidia.Hernandez-Torres@dss.ca.gov

707-588-5099 - FAX
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:Leslie Lepori
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2021


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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001833
VISIT DATE: 06/30/2021
NARRATIVE
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For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the Center Director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 06/30/2021 02:56 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 06/30/2021 at 01:27 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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001833

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/19/2021
Section Cited
CCR
101216(g)(1)

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Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.
This requirment has not been met as evidenced by: Based on staff records review. . .
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Center Director stated the staff missing the TB clearence will submitt proof to the deparment by 07/19/2021.
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. . . At 11:06AM reveling that S1, S2, and S3 did not have proof of negative TB clearance. This poses a potential health and saftey risk to children in care.
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Type B
08/14/2021
Section Cited
HSC1596.8662(b)(1)

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Center Director stated all staff missing or required to renew AB 1207 Mandated reporter traning will complete the traning and submit proof to the deparment before 08/14/2021.
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This requirement has not been met as evidenced by: based on staff records review at 11:06AM revealed Center Director's AB 1207 Mandated reporter certificate was expired. This poses a potential health and saftey risk to children in care.
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Elpidia.Hernandez-Torres@dss.ca.gov
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:Leslie Lepori
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2021


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/30/2021 02:56 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 06/30/2021 at 02:40 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
, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001833

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2021
Section Cited
HSC
1596.841

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Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
This requirment has not been met as. . .
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Center Director stated the facility roster will be completed by 07/30/2021 and will submit the completed LIC 9040 to the deparment.
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. . . evidenced by: based on center was un able to produce a completed facility roster (LIC 9040) for the school age license. This poses a potential health and saftey risk to 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:Leslie Lepori
LICENSING EVALUATOR NAME:Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2021


LIC809 (FAS) - (06/04)
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