493001831-10-10-2022-01-CC-YYAG-CK3L87-20221010083130

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493001831
Report Date: 10/07/2022
Date Signed: 10/10/2022 08:31:37 AM

Document Has Been Signed on 10/10/2022 08:31 AM - 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 CENTER		FACILITY NUMBER:	493001831
ADMINISTRATOR:	PEPPER, ALEXANDRIA		FACILITY TYPE:	850
ADDRESS:	6150 STATE FARM DRIVE		TELEPHONE:	(707) 584-0124
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY:	96	CENSUS: 32	DATE:	10/07/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	11:11 AM
MET WITH:	Alexandria "Alex" Pepper, Center Director		TIME COMPLETED:	02:15 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

An unannounced case management visit was made to the facility by Licensing Program Analysts (LPAs) Y. Yang and C. Fernandes-Goes in response to a self reported, lack of supervision incident involving child C1 and C2 and staff S1 and staff S2 that occurred on 09/27/22. During today’s visit, the LPA met with the center director, Alex Pepper to discuss the incident.

It was reported by center director Pepper that on 09/27/22, while on the center's main preschool playground, child C1 and C2 separated from their classmates and returned to the “preschool classroom” without the supervision or escort of a staff member. The center director stated that the preschool classroom is adjacent to the main preschool play yard and has its own unlocked door that leads from the classroom to the play yard. The center director reported that based on the “Child Supervision Record” (CSR) for the day, Staff S1 and S2 were supervising a total of 21 children at the time. The center director reported that as S1 and S2 were attending to a child who was having a behavioral episode on the play yard, C1 and C2 opened the door to the adjacent classroom and went inside without the staff’s knowledge. The center director stated that C1 and C2 were in the classroom without staff supervision for approximately 10-15 minutes before being spotted by a staff member (S3) walking by the classroom. The center director reported that S3 then escorted C1 and C2 back to their group, on the play yard.

The center director stated that staff are required to perform “name to face” checks at every transition and update the CSR. The center director reported that the checks were completed during the indoor to outdoor transition and while in the play yard. However, the center director reported that a second head count was not completed after the child’s behavioral incident. This self reported incident was reported to CCLD as required per regulations. During today’s case management visit, no children were observed to be left without supervision.

Based on available information, it has been determined that preschool staff S1 and S2 did not provide adequate supervision to child C1 and C2 during the incident on 09/27/2022. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. This is a repeat violation, and a civil penalty will be assessed. This report was read and reviewed with the center director, Alex Pepper. Notice of site visit shall be posted for 30 days. Appeal rights provided.

SUPERVISOR'S NAME: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang Yang	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

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 2

Document Has Been Signed on 10/10/2022 08:31 AM - 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: 493001831
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/07/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/14/2022 Section Cited	1 2 3 4 5 6 7	Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by: based on the center director's admission on 10/07/22 and the unusual incident report (UIR) submitted to CCLD on 09/28/22 that on 09/27/22 at approximately 11:30am, child C1 and C2 were left without supervision of a teacher for approximately five to ten minutes while in a preschool classroom before being reunited with their class.
	8 9 10 11 12 13 14	This presents a potential threat to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Alexis Hollon	TELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang Yang	TELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2