198005945-5-19-2023-54-CC-KCHS-CSJVV4-20230606164540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198005945
Report Date: 05/19/2023
Date Signed: 05/19/2023 02:28:33 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2023 and conducted by Evaluator Warren Birks

PUBLIC

COMPLAINT CONTROL NUMBER: 54-CC-20230308154645

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	198005945
ADMINISTRATOR:	JENNIFER HOLLANDSWORTH		FACILITY TYPE:	830
ADDRESS:	5251 E. LAS LOMAS		TELEPHONE:	(562) 961-8882
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	56	CENSUS: 39	DATE:	05/19/2023
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Jennifer Hollandsworth		TIME COMPLETED:	02:26 PM

ALLEGATION(S):

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Staff fed infant food items listed as an allergy

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced complaint inspection to deliver findings for the above allegation. LPA met with Director Jennifer Hollandsworth who provided information and assistance for the inspection.

During the course of the investigation, LPA conducted interviews with three infant staff who cared for child #1, the Assistant Director and the Director. LPA also reviewed child #1's September 15, 2022 allergy record and a September 16, 2022 Needs and services plan (both indicating child #1 is egg intolerant/allergic). LPA also reviewed a December 27th, 2022 report (states child touched an allergic food item but did did not eat it).

However, LPA received corroborated disclosure that child #1 ate a small amount of eggs. LPA received inconsistant disclosure regarding the manner in which the child obtained the eggs (by grabbing from another child's tray or being served a small amount before removing the egg item from child #1). Note: All staff interviewed indicated child #1 was monitored and did not exhibit symptoms of food intolerance that day.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 54-CC-20230308154645

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 198005945
	VISIT DATE: 05/19/2023

NARRATIVE

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Based on interviews and documentation, the preponderance of evidence standard has been met. therefore the above allegation is found to be SUBSTANTIATED.

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. This report along with a copy of the appeal rights was provided. Exit interview conducted with Director

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC9099 (FAS) - (06/04)

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Control Number 54-CC-20230308154645

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 198005945
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/15/2023 Section Cited CCR 101427ab(3)g(c)	1 2 3 4 5 6 7	Infant Care Food Service: (a) In addition to Sections 101227, the following shall apply: (b) There shall be an individual feeding plan for each infant. (3) The plan shall include the following items:...... (G) Food allergies......(c) The infant shall be fed in accordance with the individual plan.	1 2 3 4 5 6 7	Director Hollandsworth indicated that children are spaced dinstanced enough during meal times to where they can not touch each other's food trays. Director also provided LPA with a copy of Title 22 infant food service signed by infant staff indicating they read the information.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: LPA received corroborated disclosure that child #1 ate a small amount of eggs which is not part of the child #1 diet plan (allergic to eggs). This is a potential risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren Birks	TELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC9099 (FAS) - (06/04)

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