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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003051
Report Date: 10/08/2024
Date Signed: 10/08/2024 03:14:18 PM


Document Has Been Signed on 10/08/2024 03:14 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198003051
ADMINISTRATOR:MARYAM MASSOUDIFACILITY TYPE:
850
ADDRESS:1650 STONER CREEKTELEPHONE:
(626) 965-3550
CITY:CITY OF INDUSTRYSTATE: CAZIP CODE:
91748
CAPACITY:48CENSUS: 24DATE:
10/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Hsiang Yu Chen, Assistant DirectorTIME COMPLETED:
03:30 PM
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On 10/08/2024, Licensing Program Analyst (LPA) Kruz Long conducted an unannounced case management inspection. A COVID-19 risk assessment was conducted. LPA met with Hsiang Yu Chen, Assistant Director and explained the purpose of the visit. There are 24 children with 2 staff members during time of visit.

The purpose of the visit is to follow up on an incident that occurred on 10/03/2024 and was reported to the department on 10/04/2024. The self reported incident is regarding personal rights.

During today's inspection, LPA obtained a copy of the children roster and interviewed Staff #1 (S1), Staff #2 (S2), Staff #3 (S3) and attempted to interview Child #1 (C1).

There are no deficiencies being cited today as the incident requires further investigation.

An exit interview was conducted and a copy of this report was provided to the Assistant Director.

A Notice of Site Visit was provided; Notice of Site Visit must be posted for 30 days.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Kruz LongTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/08/2024
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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