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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018944
Report Date: 11/16/2020
Date Signed: 11/16/2020 10:53:08 AM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198018944
ADMINISTRATOR:MARYAM MASSOUDIFACILITY TYPE:
830
ADDRESS:1650 STONER CREEK RD.TELEPHONE:
(626) 965-3550
CITY:CITY OF INDUSTRYSTATE: CAZIP CODE:
91748
CAPACITY:32CENSUS: 5DATE:
11/16/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Maryam Massoudi TIME COMPLETED:
11:05 AM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on/or around 05/28/2020. LPA Mora met with Director, Maryam Massoudi.

A day care child sustained injuries on/or around 05/28/20. During the course of the investigation, interviews were conducted with facility staff, children and other possible witnesses. A facility roster and identifying information was obtained during a subsequent visit to the facility.

During the investigation of this incident it was found that staff were aware of the child’s questionable injuries. Facility staff failed to properly supervise by not following through with what was observed on the child. Specifically, facility staff failed to notify the facility administration and the child’s authorized representative of the injuries that were observed. A laps in communication between staff and facility administration resulted in the facility not reporting this incident as required to the Department. The facility is therefore being cited for failure to report this incident to the Department within the required 24 hours.

The deficiency listed on the following page was observed and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d.

Deficiency that is being cited needs to be cleared to protect the children’s health & safety.

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. Appeal rights explained & provided.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2020
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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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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198018944
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2020
Section Cited

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Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the
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information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.Events reported shall include the following:Any injury to any child that requires medical treatment.
This requirement was not met as evidenced by interviews conducted with facility staff and witnesses. Facility staff did not follow through on what was visually observed on the child. Facility staff failed to properly notify the facility administration and the child’s authorized representative of the injuries that were observed. This was a potential risk to the health and safety of 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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2020
LIC809 (FAS) - (06/04)
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