Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334808838
Report Date: 04/13/2017
Date Signed 04/13/2017 12:08:45 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:KARI SANDERSFACILITY TYPE:
830
ADDRESS:1655 HIDDEN VALLEY PARKWAYTELEPHONE:
(951) 898-5677
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:24CENSUS: 13DATE:
04/13/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Kari SandersTIME COMPLETED:
12:15 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
Licensing Program Analyst (LPA) Ana Noble arrived to the facility to follow up on an Unusual Incident Report, initiated by LPA on this date. A case management visit is being conducted regarding, receipt of an Unusual Incident Report (UIR) that occurred at the facility on 4/4/2017. The UIR was received by the licensing agency.

Facility records were reviewed during this visit. At the time of visit, LPA interviewed Staff, however, one pertinent witness was not present. LPA will be extending to gather additional information and interview Staff that was not present during this visit.

An exit interview was conducted with Kari Sanders and a copy of this report was provided to facility staff.

A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 782-6646
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2017
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 1