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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493001830
Report Date: 01/26/2024
Date Signed: 01/26/2024 03:16:12 PM

Document Has Been Signed on 01/26/2024 03:16 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:
493001830
ADMINISTRATOR:PEPPER, ALEXANDRIAFACILITY TYPE:
830
ADDRESS:6150 STATE FARM DRIVETELEPHONE:
(707) 584-0124
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY: 40TOTAL ENROLLED CHILDREN: 13CENSUS: 6DATE:
01/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Alexandria "Alex" PepperTIME COMPLETED:
02:50 PM
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A case management inspection was completed today for the purpose of verifying that two excluded former staff members (staff S1 and S2) are no longer present in the facility. During today's visit, the LPA met with the center director, Alexandria Pepper. The Department's Legal Division issued a Decision and Order stating that former staff S1 and S2 are excluded from any care facility licensed by the Department for the remainder of their life, effective 01/29/2024. During the visit LPA did not observe S1 or S2 to be present at the facility. The center director stated during the visit that S1 and S2 were terminated from employment at the facility in August 2023 and have not been at the facility since that date. LPA has verified that S1 and S2 are no longer present at the facility.

This report was reviewed with the center director, Alexandria Pepper. There were no Title 22 deficiencies issued during today's visit. Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
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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