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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005944
Report Date: 10/26/2023
Date Signed: 10/26/2023 01:52:39 PM


Document Has Been Signed on 10/26/2023 01:52 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:117CENSUS: 88DATE:
10/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Regina RamirezTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted a Case Management Incident inspection. This inspection is regarding an injury incident that took place in a facility restroom on October 10, 2023. LPA met with visiting Director Regina Ramirez who provided information and assistance during the inspection.

LPA conducted interviews with staff #1, staff #2, and visiting Director Ramirez. LPA conducted an attempted interview with child #1. LPA also inspected the restroom which appeared to have no immediate hazards at time. During interviews, LPA received corroborating disclosure that child #1 alerted staff from the restroom that something was wrong with child #1's nose.

LPA received disclosure that child #1 was using the restroom for approximately (3) three minutes and staff #1 was approximately five (5) feet away from the restroom. However, child #1 was not in view and therefore staff did not witness the incident or bruising or injury. The facility was later notified by adult #1 that child #1 had a visible injury inside the nose. Staff indicated that child #1 may have fell but didn't witness the incident. The facility is cited under Title 22 Regulations for Lack of Supervision as child #1 was unsupervised in the restroom for approximately three (3) minutes.

LPA made an attempt to interview child #1 for more details however, child #1 was unable to answer questions. LPA received no medical records regarding the injury and LPA observed child #1 appear to be conducting normal activities unrestricted.

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 Visiting Director Regina Ramirez.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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 10/26/2023 01:52 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: 10/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/02/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: ......No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Visiting Director Regina Ramirez indicates that staff will be trained on care and supervision and evidence of training will be submitted to Child Care Licesning.
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This requirement was not met as evidenced by: LPA received disclosure that child #1 had an injury during a restroom break. Staff was approximately 5 feet away however, the child was out of view. 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: 10/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
LIC809 (FAS) - (06/04)
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