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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270484
Report Date: 07/12/2024
Date Signed: 07/12/2024 10:06:44 AM


Document Has Been Signed on 07/12/2024 10:06 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
304270484
ADMINISTRATOR:VASSEGHI, MOJGANFACILITY TYPE:
850
ADDRESS:30062 SANTA MARGARITA PARKWAYTELEPHONE:
(949) 888-8880
CITY:RANCHO STA MARGARISTATE: CAZIP CODE:
92688
CAPACITY:78CENSUS: DATE:
07/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Director Mojgan VasseghiTIME COMPLETED:
10:30 AM
NARRATIVE
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On 07/12/24 at 9:05AM, Licensing Program Analyst (LPA), Christine Jung conducted an unannounced case management inspection to follow up on an incident that was self-reported to the Department. Upon arrival, LPA met with Director, Mojgan Vasseghi. LPA disclosed the purpose of the inspection and was led on a tour of the facility. There were 37 children and 5 staff members present. Hours of operation are Monday through Friday 6:30 a.m. to 6:30 p.m.

On 06/13/24, facility reported Staff 1 (S1) stated they heard Child 1 (C1) crying on the play structure at 5:15PM. S1 observed C1 to be on top of the structure. C1 was unable to climb down, so S1 climbed up the structure and carried C1 down. S1 stated C1 was not able to stand and was holding C1 when C1’s authorized representative arrived at the facility. S1 stated that C1’s authorized representative observed C1 to be shaking. S1 stated that C1 was pointing to their leg saying “ow, ow,” so S1 concluded that C1 had fallen during play. Facility was informed on 06/13/24 C1’s leg was broken.

LPA conducted an initial case management inspection on 6/19/24 to follow up on the incident at the facility. LPA was provided with medical records, interviewed C1’s authorized representative, and interviewed facility teachers and teacher's assistants. Four (4) out of four (4) teachers and teacher’s assistants interviewed stated they did not witness the incident; therefore, the licensee is being cited for lack of supervision; see LIC809D for Type A deficiency cited.
LPA informed Director, Mojgan Vasseghi, that this report dated 07/12/24 documents 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPA informed Director to provide a copy of this licensing report dated XXX that documents any Type A citation 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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Mojgan Vasseghi.
SUPERVISOR'S NAME: Martha MalaneTELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Soo Jin JungTELEPHONE: (714) 293-5262
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024
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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Document Has Been Signed on 07/12/2024 10:06 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 COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270484

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/12/2024
Section Cited
CCR
101229(a)(1)

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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:
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Director conducted a staff meeting and has decided to allow only one class at a time on the playground. One staff will arrive on the playground first and another staff will follow the group of children from behind to ensure visual observation at all times. Director will submit signed LIC 9224 to LPA by next businness day.
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Based on interviews, the facility did not ensure visual observation of children in care, which poses an immediate risk to the health, safety, and personal rights of the clients in care.
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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: Martha MalaneTELEPHONE: (310) 740-3022
LICENSING EVALUATOR NAME: Soo Jin JungTELEPHONE: (714) 293-5262
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2024
LIC809 (FAS) - (06/04)
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