364830081-1-18-2023-12-CC-APIN-CN835A-20230118165626

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364830081
Report Date: 01/18/2023
Date Signed: 01/18/2023 04:56:37 PM

Document Has Been Signed on 01/18/2023 04:56 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 CENTER		FACILITY NUMBER:	364830081
ADMINISTRATOR:	BRIANNE HINDMAN		FACILITY TYPE:	840
ADDRESS:	13615 BEAR VALLEY ROAD		TELEPHONE:	(760) 949-8539
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	38	CENSUS: 84	DATE:	01/18/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Jennifer Johnson-Director		TIME COMPLETED:	05:15 PM

NARRATIVE

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On Jan. 18th, 2023 at 10:10am, Licensing Program Analyst (LPA) Andrea Pittman and Licensing Program Manager (LPM) Mariela Ramon arrived at the facility for the purpose to conduct a case management incident inspection to follow-up on an unusual incident that occurred on 12/2/2022 and was reported to the Department on 12/2/22.

The Unusual Incident Report indicates that on 12/02/22, child #1 and child #2 went to the restroom area to wash after coming from the playground. While child #1 and child #2 were in the restroom, child #1 had inappropriate contact with child #2.

During today's inspection, LPA and LPM conducted interviews with child #1, child #2, staff, director, and other relevant parties to the unusual incident. The information obtained revealed child #1 and child #2 with 19 children were transitioning from the play ground to the classroom. Children were being supervised by Staff #1 and Staff #2. Inconsistent statements were provided as to what Staff #1 and Staff #2 were doing during the transition of the children into the classroom. Staff #1 was hanging coats up when she went to check on the children who were inside the restroom washing their hands. Staff #1 witnessed Child #2 at the sink washing his hands when she witnessed Child #1 having inappropriate contact with Child #2. Staff #1 had them come out the restroom and explained to Staff #2 about what was witnessed. Staff #1 brought Child #1 and Child #2 to the Director's office to contact their parents to notify them about the incident. Staff #1 spoke to the children about inappropriate touching.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

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: 364830081
	VISIT DATE: 01/18/2023

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The guardians of Child #1 and Child #2 were notified and picked up the children shortly after the incident occurred.

Based on the information gathered from the interviews conducted with the Director and staff that supervised child # 1 and child # 2 on the day of the incident, there is sufficient information to state that during this incident, the facility staff failed to provide proper care and supervision to child # 1 and child # 2. An immediate civil penalty in the amount of $500 dollars was assessed as of result of the absence of supervision.

Facility reported the incident on a timely manner via telephone and in writing.

Facility was cited type A deficiency. See Facility Evaluation Report LIC 809D for deficiencies cited.

Facility is to post a copy of the licensing report LIC809 along with the Notice of Site Visit for 30 days. Copies of the reports must also be provided to parents of all enrolled children, and obtain their signature on LIC9224, as required by Senate Bill AB633. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. The Facility is encouraged to continue to report Unusual Incidents that occur at the facility.

An exit Interview was conducted, a copy of this report was provided along with the appeal rights.

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/18/2023 04:56 PM - It Cannot Be Edited

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: 364830081
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/19/2023 Section Cited	1 2 3 4 5 6 7	Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time. This requirement is not met as evidenced by the incident occurring on 12/2/2022, child # 1 had inappropriate contact with child # 2. Staff #1 and Staff #2 supervising child # 1 and child # 2	1 2 3 4 5 6 7	1Director shall provide LPA with a plan for care and supervision concerning the usage of restrooms by children in care. The plan should entail their process to ensure children are observed at all times. Director shall institute a plan to ensure children are supervised at all times while using the
	8 9 10 11 12 13 14	admitted the incident occurred; however, did not observe when child # 1 initiated the inappropriate contact with child # 2. Staff must provide supervision at all times. This is a Type A deficiency and it poses an immediate risk to the health and safety to the children in care. An immediate civil penalty in the amount of $500 dollars was assessed as of result of the absence of supervision.	8 9 10 11 12 13 14	restroom and provide training to all Staff concerning the new routine to prevent similar incidents reoccurring in the future. The plan must be submitted to the department no later than 1/19/2023.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Andrea Pittman	TELEPHONE: 661-202-3375
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023

LIC809 (FAS) - (06/04)

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