Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334808838
Report Date: 02/04/2016
Date Signed 02/04/2016 08:04:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
334808838
ADMINISTRATOR:PRISCILLA CARMONAFACILITY TYPE:
830
ADDRESS:1655 HIDDEN VALLEY PARKWAYTELEPHONE:
(951) 898-5677
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:24CENSUS: 12DATE:
02/04/2016
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Priscilla CarmonaTIME COMPLETED:
07:55 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
A health and safety review visit (1) is being conducted as a compliance review. Licensing Program Analyst (LPA), Kim Leung, toured the infant center, inside and out. The following was observed:

· The facility is operating within the terms of the license
· Ratios were met during this visit
· Appropriate supervision was provided during the visit
· Rooms are physically separated from other components
· Rooms are equipped with age appropriate furniture and equipment in good condition
· Napping equipment meets licensing requirements.
· Rooms are clean and free of hazards
· No weapons stored at the facility as stated by facility director Priscilla Carmona
· Medications are stored in the wall cabinets where inaccessible to infants
· Hazards are stored where inaccessible to infants
· Toxins are locked
· Toileting area was observed to be safe, sanitary and in operating condition
· Outdoor play area is physically separated by appropriate fencing and free of hazards
· Outdoor activity areas are supplied with age and size appropriate equipment in good condition
· Food preparation area is clean and free of vermin
· Food is stored appropriately and protected from contamination
· Individual feeding plans were reviewed
· Infant needs and services plans were reviewed
· Sign in/Sign out record was reviewed and meets regulation requirements
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2016
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334808838
VISIT DATE: 02/04/2016
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
26
27
28
29
30
31
32
· Staff member’s CPR/First Aid expires on 7/26/17 (Lidia Alvarez)
· Staff qualifications were reviewed. Verification is not available for review to support that a staff member who is hired as a teacher and has been performing teacher's duties meets the teacher qualification requirements per Title 22 Regulations.
· Required emergency contact forms were reviewed
· A review of staff records on 2/4/2016 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

See LIC 809D for deficiency cited.

· The facility representative was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.
· AB 978 – Zero Tolerance Related Regulations went into effect January 18, 2011 – In accordance with California Health and Safety Code Section 1596.99(c)/1597.58(c) – it was explained that an immediate $150 Civil penalty will be assessed for each serious violation and a civil penalty of $150 per day per violation will be assessed until corrected.

An exit interview was conducted with Ms. Carmona, appeal rights discussed, Notice of Site Visit was issued and must be posted for 30 days. Ms. Carmona was provided with a copy of the appeal rights (LIC9058 12/2015) and her signature on this report acknowledges receipt of those rights. A copy of this report was provided.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2016
LIC809 (FAS) - (06/04)
Page: 2 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 334808838
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/04/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2016
Section Cited
101416.2(a)
1
2
3
4
5
6
7
Infant Care Teacher Qualifications and Duties. Verification is not available for review to support that a staff member who is hired as a teacher and has been performing teacher's duties meets the teacher qualification requirements per Title 22 Regulations.
1
2
3
4
5
6
7
Director Priscilla Carmona states that the staff member would be working as an aide assisting a qualified teacher until verification of qualifications is availabe for review. Written statement from Ms. Carmona was submitted during visit.
8
9
10
11
12
13
14
Having unqualified staff supervise children alone and work in the capacity of a teacher poses potential risk to the children's health and well being.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2016
LIC809 (FAS) - (06/04)
Page: 3 of 3