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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191204383
Report Date: 12/13/2019
Date Signed: 12/16/2019 08:52:23 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
191204383
ADMINISTRATOR:JACQUELINE MORSEFACILITY TYPE:
850
ADDRESS:16901 LASSEN STREETTELEPHONE:
(818) 368-5334
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY:60CENSUS: 30DATE:
12/13/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Christina Barton-Torp/Assistant DirectorTIME COMPLETED:
04:10 PM
NARRATIVE
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On 12/3/2019, Licensing Program Analyst (LPA) Silva Garibyan conducted a Case Management - Deficiencies inspection for the purpose of citing the deficiencies that were observed on the visit date of 12/13/2019.

The following deficiency was observed:

Licensee failed to report the unusual incident ( gas leak) occurred on 10/28/2019.

A copy of this report, notice of site visit and appeal rights were provided and an exit interview was conducted with

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 191204383
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/27/2019
Section Cited

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Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be
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 submitted to the Department within seven days following the occurrence of such event. This requirement is not met as evidenced by: Licensee failed to report the unusual incident ( gas leak) occurred on 10/28/2019. This poses a potential risk to the health and safety of children 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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2