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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001833
Report Date: 07/27/2023
Date Signed: 07/27/2023 05:06:55 PM

Document Has Been Signed on 07/27/2023 05:06 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
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: 50CENSUS: DATE:
07/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Assistant Center director ShirinTIME COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrived to the facility to conduct a case management visit. While attending to other matters in the facility LPA observed Staff ( S1, S2) in classroom School Age B with 24 children, and Staff (S3) in classroom School Age A with 12 children. All Staff (S1-S3) quailfy as aides, but were not under the direct supervision of a qualified teacher. All staff ( S1-S3) were not able to produce proof of completed units to qualify as a school age teacher. Type B deficiency was issued on attached 809-D.

Before LPA left the facility, Assistant Center Director moved staff around and placed qualified teachers (S4,S5) in classroom School Age B and Classroom School Age A. Notice of site visit shall be posted for 30 days. Assistant center director was given a copy of report.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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 07/27/2023 05:06 PM - It Cannot Be Edited


Created By: Elpidia Hernandez Torres On 07/27/2023 at 12:31 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
, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 483001833

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2023
Section Cited
CCR
101216.2(e)

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(e) An aide shall work only under the direct supervision of a teacher. This was not met as evidence by. . .
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LPA Hernandez Torres reviewed the teacher qualifications, teacher-aide regulations, and the alternative options for a school-age teacher. Assistant Center Director will submit the staff schedules with job title and. . .
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Based on obsevation and record review all three staff (S1-S3) were working in the capacity of a teacher under the school age license. S1-S3 did not provide the qualifications to be left alone with children as a teacher. This causes a potential health and safty risk to children in care.
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. . . proof of completed units to LPA Hernandez Torres via email, mail or fax on or before 08/10/2023.

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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: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2023


LIC809 (FAS) - (06/04)
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