493001831-5-20-2022-01-CC-YYAG-CELT32-20220520142136

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 493001831
Report Date: 05/20/2022
Date Signed: 05/20/2022 02:21:44 PM

Document Has Been Signed on 05/20/2022 02:21 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 CENTER		FACILITY NUMBER:	493001831
ADMINISTRATOR:	BROWN,MEGAN		FACILITY TYPE:	850
ADDRESS:	6150 STATE FARM DRIVE		TELEPHONE:	(707) 584-0124
CITY:	ROHNERT PARK	STATE: CA	ZIP CODE:	94928
CAPACITY:	96	CENSUS: 13	DATE:	05/20/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Tiffany Dougherty		TIME COMPLETED:	12:06 PM

NARRATIVE

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An unannounced case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang in response to a self-reported, lack of supervision incident involving child C1 and staff S1 that occurred on 05/02/22. During today’s visit, the LPA met with the center director, Tiffany Dougherty to discuss the incident.

It was reported by center director Dougherty that on 05/02/22, during an outdoor to indoor transition at 04:00pm, child C1 was unintentionally left on the playground while their class transitioned inside. The center director reported that based on the “Child Supervision Record” (CSR) for the day, S1 was supervising a total of nine children at the time and was the only staff member outside on the playground. The center director reported that as S1 was performing a “name to face” check to transition the nine children indoors, a daycare client showed up to pick up their child. The center director reported that S1 became confused with the total number of children in her class and inadvertently left child C1 outside on the fully fenced playground. The center director reported that C1 was left on the playground for approximately five minutes before being discovered by C1’s mother, a staff member at the center.

Center director Dougherty reported that on 05/03/22, staff S1 was provided “coaching” regarding the proper use of the CSR form along with outdoor to indoor transitions. In addition, the center director reported that on the facility’s 05/10/22 staff meeting, additional training regarding the proper use of the CSR and transitions were provided to preschool staff. Center director Dougherty reported that she notified KinderCare District Leader, Jennifer Liu along with the CCLD childcare desk duty officer of the day, and her assigned LPA regarding the incident. This self-reported incident was reported to CCLD as required per regulations. During today’s case management visit, the LPA observed 13 children being supervised by 2 staff members. No children were observed to be left without supervision.

Based on available information, it has been determined that preschool staff S1 did not provide adequate supervision to child C1 during the incident on 05/02/2022. The following violation of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. This report was read and reviewed with the center director, Tiffany Dougherty. 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: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

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 05/20/2022 02:21 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: 493001831
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/20/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/20/2022 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: the center director's admission on 05/20/22 and the unusual incident report (UIR) submitted on 05/03/22 that on 05/02/22 at approximately 04:00pm, child C1 was left without supervision of a teacher for approximately five minutes while on the fully fenced playground during an outdoor to indoor transition. This presents a potential threat to the health and safety of children in care.
	8 9 10 11 12 13 14		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: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

LIC809 (FAS) - (06/04)

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