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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830081
Report Date: 09/03/2021
Date Signed: 09/03/2021 12:04:27 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: 0DATE:
09/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Jennifer JohnsonTIME COMPLETED:
12:18 PM
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Licensing Program Analysts (LPA's) Justin Dorsey & Babatunde Ibitoye spoke with director, Jennifer Johnson, for the purpose of conducting a follow-up on a Case Management Unusual Incident Report (UIR) from the facility. This UIR was received by Licensing on 07/20/2021.

Description of incident: On 07/20/21, Child #1 was playing with a toy when Child #2 took the toy from them. When Child #2 wouldn't give the toy back Child #1 attempted to kick Child #2 in the face but it was blocked. After Child #2 blocked the kick they punched Child #1 in the stomach and the face causing a fat lip, bleeding and tooth to be knocked out. According to the Unusual Incident Report Teacher #1 was in the classroom preparing the tables for lunch when the incident occurred.

During this investigation, LPA interviewed Director and guided on a tour of the center. During the visit it was found that Teacher #1 and Child #1 were not present. LPA’s were also told by the Director that Child #2’s last day was on 07/21/21. LPA Dorsey also reviewed the facilities child and staff sign in sheet for 07/20/21 and found that the classroom was in ratio during the time of the incident. LPA's will attempt to interview Child #1 and Staff #1 during a future visit.



Notice of Site Visit shall be posted for for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview was conducted with and a copy of this report has been signed by and provided to director Jennifer Johnson. The Notice of Site Visit and Appeal Rights were given.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2021
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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