304270381-11-10-2022-06-CC-DTHN-CL2QCL-20221110110319

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270381
Report Date: 11/10/2022
Date Signed: 11/10/2022 11:03:25 AM

Document Has Been Signed on 11/10/2022 11:03 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	304270381
ADMINISTRATOR:	MIRANDA MCNEILL		FACILITY TYPE:	840
ADDRESS:	25507 MOULTON PARKWAY		TELEPHONE:	(949) 470-0099
CITY:	ALISO VIEJO	STATE: CA	ZIP CODE:	92656
CAPACITY:	38	CENSUS: 6	DATE:	11/10/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Miranda McNeill		TIME COMPLETED:	11:30 AM

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Licensing Program Analyst (LPA ) Thompson conducted an on-site inspection for the purpose of a Case Management Incident Inspection on 11/10/22. LPA Thompson met with Director Miranda McNeill. There was a total of 6 school age children present with 1 staff at the time of visit.

A review of staff criminal clearance records on this date indicated that all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Today's Case Management inspection is being conducted in response to a self reported incident, reported to the Orange County Community Care Licensing Regional Office on 11/01/22, detailing child #1 (C1) had an allergic reaction during lunch. Staff was aware C1 had a seafood allergy, and C1 was served fish nuggets for lunch.

At the time of the incident C1 began vomiting and was given Benadryl. Approximately five (5) minutes after C1 was given the Benadry, staff noticed C1 started to get hives and was having difficulty breathing so director administered an Epi-pen prescribed for C1. 911 was called by director and EMT's arrived.

During the inspection, LPA interviewed Director and staff (S1) who was directly involved in the incident, as well as inspected the kitchen where the allergy list is placed.

Based on LPA observations, child file review, and interviews conducted, the preponderance of evidence standard has been met. Facility failed to meet the needs of the child in care and served an item listed as an allergic item on LIC 702 Child's Preadmission Health History-Parents Report, Needs and Service Plan , and Allergy list for C1 which poses an immediate risk to Health and Safety.

California Code of Regulations, Title 12, Division 22 Section 101227(7)(B) is being cited for Food Services.

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SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 304270381
	VISIT DATE: 11/10/2022

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LPA Thompson informed Director Miranda McNeill that this report dated 11/10/2022 document(s) one Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Thompson informed the Director Miranda McNeill to provide a copy of this licensing report dated 11/10/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director Miranda McNeill . A notice of site visit was given and must remain posted for 30 days.

Appeal Rights were explained. Director was provided a copy of appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/10/2022 11:03 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 304270381
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/10/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/17/2022 Section Cited	1 2 3 4 5 6 7	101227 Food Service (7) Modified diets prescribed by a child's physician as a medical necessity shall be provided. (B) A child shall not be served any food to which the child's record indicates he/she has an allergy. The above requirement is not met by:
	8 9 10 11 12 13 14	evidence of facility serving an allergic item (fish) to Child #1 during lunch time and the Item was listed on Needs and Service Plan, Allergy list, and LIC 702 Child's Preadmission Health History-Parents Reportwhich was received upon admission by the facility. This poses an immediate risk to Health and Safety to children in care.	8 9 10 11 12 13 14	LIC421IM Immediate Civil Penalty was issued on 11/10/2022.
	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: Judy Hanson	TELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Dean Thompson	TELEPHONE: (714) 287-0708
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022

LIC809 (FAS) - (06/04)

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