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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403509
Report Date: 05/15/2019
Date Signed: 05/15/2019 12:26:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
197403509
ADMINISTRATOR:TERRY, ADRIANAFACILITY TYPE:
840
ADDRESS:43536 22ND STREET WESTTELEPHONE:
(661) 948-3570
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:45CENSUS: DATE:
05/15/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Tenaea Bossett Michelle Moore TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Lady King-Lewis met with Assistant Director Michelle Moore, and Site Supervisor Tenaea Bossett for a Case Management Incident inspection. A self reported Incident Report dated 05-13-19. The incident occurred on 05-10-19.


Description of the incident: child#1, grandmother made inappropriate statement to child #2

Interviews were conducted with staff. It was determined staff was near child #2 when the incident took place. Assistant Director was notified immediately as well as the parent of child #2 who is a teacher at the center. Child #1 and child #2 are still enrolled and currently attends the center.

Based on the information provided, further investigation is needed.

Notice of Site Visit form was given to be posted for 30 days.

An exit interview was conducted, and a copy of this report was read and provided to the Assistant Director, Michelle Moore, on this day.

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 789-6952
LICENSING EVALUATOR NAME: Lady KingTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2019
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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