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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005944
Report Date: 05/31/2023
Date Signed: 05/31/2023 05:29:47 PM


Document Has Been Signed on 05/31/2023 05:29 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198005944
ADMINISTRATOR:JENNIFER HOLLANDSWORTHFACILITY TYPE:
850
ADDRESS:5251 E. LAS LOMASTELEPHONE:
(562) 961-8882
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:105CENSUS: 94DATE:
05/31/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:22 PM
MET WITH:Jennifer HollandsworthTIME COMPLETED:
05:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted a Case Management Incident inspection. This inspection is regarding an incident that took place on May 24, 2023. LPA met with Director Jennifer Hollandsworth who provided information and assistance during the inspection.

LPA conducted interviews with staff #1, staff #2, parent #1 and Director. LPA also attempted to conduct interview with child #1 who was non verbal. Staff #1 and staff #2 took LPA to the outdoor play area where they witnessed the incident take place. LPA received corroborated disclosure from staff #1, staff #2 and the parent #1 indicating that staff #3 grabbed and pulled child #1 by the arm in order to make child #1 go in a direction staff #3 wanted him to go. Staff #2 and parent #1 also disclosed that staff #3 grabbed/pulled child #1 by the shirt in order to stop child #1 from running away. Parent #1 indicated that child #1 sustained bruising from the incident. LPA observed no bruising on the child at this time. Parent #1 indicated pictures will be sent to LPA at a later time. LPA will attempt to interview staff #3 at a later date as staff #3 was unavailable at this time.
LPA informed Director that based on interviews the facility is cited for Personal Rights as staff #3 grabbed and pulled child #1 by the arm and shirt in a punitive nature (to make child #1 move in the direction staff #3 wanted the child to go).

A copy of this report must be provided to the parent or guardian of every child and (including any newly enrolled children) for the next 12 months. The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent/guardian). Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) form.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Director Jennifer Hollandsworth.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
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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Document Has Been Signed on 05/31/2023 05:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198005944

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/01/2023
Section Cited
CCR
101223(a)(3)

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Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to:
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Director Hollandsworth indicated that she handed out the Guidance Protection and Respect for Children's Policy along with Personal Rights Licensing forms to staff. Director will also have staff watch CDSS Personal Rights videos. Director to provide proof of receipt by staff.
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interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement was not met as evidenced by: LPA received corroborated staff and parent #1 disclsosure that child #1 was grabbed and pulled by the arm and shirt by staff #3 (to make child go in a direction staff #3 wanted the child to go in). This is an immediate risk to 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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2023
LIC809 (FAS) - (06/04)
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