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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403513
Report Date: 05/17/2019
Date Signed: 05/20/2019 04:15:03 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:
197403513
ADMINISTRATOR:ILIANA FARALDOFACILITY TYPE:
830
ADDRESS:18525 W. SOLEDADTELEPHONE:
6612519176
CITY:CANYON COUNTRYSTATE: CAZIP CODE:
91351
CAPACITY:20CENSUS: 53DATE:
05/17/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Christina Barton-TorpTIME COMPLETED:
11:34 AM
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Licensing Program Analyst (LPA) Ortega met with Assistant Director Christina Barton-Torp, for a Case Management Incident inspection involving an Incident Report dated April 15, 2019. The incident occurred on April 12, 2019.


Description of the incident: During outdoor time, child#1 was sitting on a small bench with peers, child #1 scooted back, this resulted in child#1 falling hitting her forehead on the bench causing a small laceration on child#1's forehead which required stiches.

Interviews were conducted with parents and staff. Child #1 was present on this day. It was determined Child #1 accidentally fell, losing her balance and was hurt on her forehead causing a small laceration. Staff #1 witnessed the incident. Parent was notified in a timely matter and Child #1 was taken to the hospital by parent. Child#1 returned to day care within two days.

Based on information provided and interviews conducted the incident does not appear to have been the result of any violation of the Title 22 regulation, therefore no deficiencies were cited.

During inspection unusual incident/injury report findings were provided and read to Assistant Director.
An exit interview was conducted and a copy of this report was read and provided to the Assistant Director, Christiana Barton-Torp.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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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