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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001837
Report Date: 01/06/2023
Date Signed: 01/06/2023 03:23:00 PM


Document Has Been Signed on 01/06/2023 03:23 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
483001837
ADMINISTRATOR:CANARIOS, ROSEFACILITY TYPE:
830
ADDRESS:35 ROTARY WAYTELEPHONE:
(707) 557-3007
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:36CENSUS: 24DATE:
01/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Justice Willis - Assistant Center DirectorTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA), Melchisedeck Augustin conducted an unannounced Case Management visit and met with Assistant Center Director, Justice Willis (AD) for the purpose of citing potential risk violations that was observed during the visit. At 9:00am, LPA observed 16 infants in care with three staff (S1, S2 & S3) in the infant classroom, and of the 16 children, a child (C1) under 12 months old that was unable to climb out of the crib was laying on his/her side, covered with a blanket, and napping on a pillow/cushion on the ground instead of a crib. Shortly after the deficiency was noticed by LPA, a staff transferred C1 to a crib in the napping area and AD claimed that in the morning, the facility combined infant and Toddler classrooms. LPA conducted record review for C1, and according to C1's Individual Infant Sleeping Plan (LIC 9227), C1 had the ability to roll from his/her back to the stomach and vice versa. The facility did not comply with requirements of California Code of Regulations (CCR) for Infant Care Center Sleeping Equipment.

The following deficiencies are being cited (see LIC 809D). Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Center Director, Donje Fields.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023
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 01/06/2023 03:23 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
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 CENTER

FACILITY NUMBER: 483001837

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/20/2023
Section Cited

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Staff shall place infants up to 12 month of age on their backs for sleeping.

This requirement is not met as evidenced by: Based on LPA's observations of a child (C1) under 12 months old that was unable to climb out of the crib was laying on his/her side, covered with a blanket, and napping on a
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Center Diector stated already had an all staff meeting scheduled on 01/13/23, and the Director would review CCR 101430(A). Center Director stated she would submit a copy of the staff attendance sheet, as well as the agenda detailing the topics discussed during the meeting.
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pillow/cushion on the ground. This poses/posed a potential health, safety and or personal rights risk to the child(ren) in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
Type B
01/16/2023
Section Cited

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If an infant falls asleep before being placed in a crib, staff shall move the infant to a crib as soon as possible.

This requirement is not met as evidenced by: Based on LPA's observations of a child (C1) under 12 months old that was unable to climb out of the crib was
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Center Diector stated already had an all staff meeting scheduled on 01/13/23, and the Director would review CCR 101430(A). Center Director stated she would submit a copy of the staff attendance sheet, as well as the agenda detailing the topics discussed during the meeting.
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napping on a pillow/cushion on the ground instead of a crib. This poses/posed a potential health, safety and or personal rights risk to the child(ren) in care.
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Email: melchisedeck.augustin@dss.ca.gov
Fax: 707-588-5099
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 LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2023
LIC809 (FAS) - (06/04)
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