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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830080
Report Date: 11/29/2023
Date Signed: 11/29/2023 02:29:30 PM


Document Has Been Signed on 11/29/2023 02:29 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
PALMDALE CHILD CARE, 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: 22DATE:
11/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Jennifer Johnson, Site DirectorTIME COMPLETED:
02:30 PM
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On November 29, 2023, Licensing Program Analyst (LPA) Calloway made an unannounced inspection to the facility. LPA met with Director who granted access. The purpose was to conduct a Case Management inspection for a UIR that was submitted via telephone 11/28/23 and in writing on 11/29/23 by the Director.

On November 28, 2023, there was an Unusual Incident that occurred between S1 and C1. Per Director (FD), C1 spoke to Assistant Director (AD) and asked to speak to the Director with a concern. C1 showed their right arm with fingernail marks and a small cut on their right pinky finger and stated S1 did it. Per Director, C1 stated they were pushing the bookshelf, throwing books, and knocked over two chairs and S1 was helping to put the books on the shelf and grabbed C1's right arm with their fingernails. Per Director, there were visible marks in C1's right arm. S2 was a witness to the incident. Photos of injury were taken, an incident report, and parents were notified on 11/28/23. S1 was placed on an Administrative leave pending review of the situation and Per Director, the parents notified the Victorville PD and today they were on site and took a report.

During the inspection, LPA obtained a copy of the facility roster, photos of the child's arm, parent's phone number, copy of the incident report, written statements from staff, and PD report number. C1 was napping at the time of inspection.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 364830080
VISIT DATE: 11/29/2023
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An exit interview was conducted and a copy of this report was read, and a Notice of Site visit were provided to Jennifer Johnson, Director at the facility. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain posting will result in a civil penalty being assessed.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023
LIC809 (FAS) - (06/04)
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