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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830080
Report Date: 02/21/2020
Date Signed: 02/21/2020 03:54:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
364830080
ADMINISTRATOR:BRIANNE HINDMANFACILITY TYPE:
850
ADDRESS:13615 BEAR VALLEY ROADTELEPHONE:
(760) 949-8539
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:88CENSUS: 78DATE:
02/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:51 PM
MET WITH:Brianne HindmanTIME COMPLETED:
04:10 PM
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Licensing Program Analysts (LPAs) Neal and Flores met with Director, Brianne Hindman today for the purpose of Case Management inspection of an Unusual Incident. This incident was self reported within time frame that meets Title 22 regulations.

Description of the incident: On 1/8/2020, Staff #1 was transitioning 7 children. Name to face was done inside classroom. Upon arrival to the playground door, Staff #1 counted 6 children and ran back inside the classroom and observed that Child #1 was still in the classroom. Per staff, child #1 was in the classroom less than a minute and brought out with the rest of the children. Parent was notified.
During this investigation, LPAs interviewed staff present, reviewed child supervision record sheet of Name to Face counts conducted. Based on information provided, proper protocol was followed and no deficiencies were issued during this inspection.
Notice of Site Visit was given.
An exit interview was conducted, report was read and a copy was provided to the Director on this date.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Jazelle NealTELEPHONE: (661) 568-8945
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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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