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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830081
Report Date: 04/05/2021
Date Signed: 04/05/2021 12:48:51 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:
364830081
ADMINISTRATOR:BRIANNE HINDMANFACILITY TYPE:
840
ADDRESS:13615 BEAR VALLEY ROADTELEPHONE:
(760) 949-8539
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:38CENSUS: 21DATE:
04/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jennifer JohnsonTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Neal met with Director, Jennifer Johnson today for the purpose of a Case Management inspection of an Unusual Incident Report (UIR) received by Licensing on 3/29/2021. This Incident was self-reported by the facility.

Description of the incident: On 3/24/2021 at approximately 3pm, Staff #1 as supervising children outside on the playground. Child #1 and Child # 2 were at the top of the jungle gym inside the tube slide. After Staff #1's inquiring of children inside the tube slide, it was revealed that child #1 had inappropriate contact with child #2. Private discussions were had with each child and parents were notified.

During this inspection, LPA interviewed staff and requested relevant documents for review. Based on information provided and interviews conducted this initial incident requires further follow-up.

An exit interview was conducted and a copy of this report was read and 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: 04/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021
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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