364830081-8-8-2023-12-CC-KZIS-CUHVWB-20230808164739

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364830081
Report Date: 08/08/2023
Date Signed: 08/08/2023 04:47:54 PM

Document Has Been Signed on 08/08/2023 04:47 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: 29	DATE:	08/08/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Facility Representative Jennifer Johnson		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On August 8, 2023 at 11:30 a.m. Licensing Program Analyst (LPA) Zirbes met with the Facility Representative Jennifer Johnson. The purpose of the inspection was to conduct an unannounced required one year inspection. LPA disclosed the purpose of the inspection to the Facility Representative. Present during today’s inspection were 29 school age children, two teachers, one aide and additional staff members. The school age program consists of two classrooms, four bathrooms, and an outdoor space. The center also operates a Infant Center (#364830082) and Preschool Program (#3648430080). All three components utilize the front office space, staff break areas, and kitchen. Indoor/Children's Area: Child care center is clean, safe, sanitary and in good repair; all outdoor and indoor passageways, stair ways, incline, ramps, open porches and other areas of potential hazard are kept free of obstruction. Cleaning compounds are stored in each classroom. The cleaning products in each classroom were stored in cabinets equipped with key locks. The furniture/equipment was good condition. During the walk through of Classroom A LPA observed the first aid supplies were stored in a half zipped backpack. The backpack was on a hook that was approximately three feet high on the wall by the exit door. LPA reminded the Center that the first-aid supplies had to be stored in a location accessible to staff but inaccessible to children. The back pack was immediately moved to a higher location by the facility staff. Based on LPA observation, the first aide supplies were not accessible to the children in care as the children were engaged in instruction on the other side of the classroom. A technical violation was provided to the Center. In addition, during LPA walk through of classroom B, LPA observed the medications were on a high shelf that was approximately five feet in height and was inaccessible to the children in care at the time of this inspection. LPA advised the Center to continue to evaluate the environment and ensure the medications are inaccessible to the taller school age children enrolled in the program. The Center was free of flies, other insects, or rodents. Each classroom was equipped with tables and chairs to meet children’s needs. All play equipment and materials used by children are age-appropriate, children have individual cubbies labelled with their name and pictures for their clothing, personal belongings. Trash cans for solid waste have tight fitting lids. Report Continued on page two

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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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Document Has Been Signed on 08/08/2023 04:47 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: 08/08/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above when five of five staff files (S1, S2, S3, S4, S5) were missing documentation of the influenza immunization. which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/22/2023
	Plan of Correction
1 2 3 4	Per facility representative, documentation of the influenza immunization or a statement declining the immunization will be added to the staff files. Staff will utilize a checklist to ensure the staff files contain all required information. The Center will conduct a review of the staff files once a year to ensure files contain all required information.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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: 08/08/2023

NARRATIVE

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Report continued from page one
All materials and surfaces are toxic free. No fireplaces were present in the preschool classrooms. Carbon monoxide detectors, smoke detector and fire extinguishers were located throughout the Center. The Center had working telephone service on the premises. There is an isolation area for children who become ill while in care. The facility maintains a comfortable temperature at all times. Sign in/out sheets were available and are completed each day. Sign in an out sheets included information for school drop off and pick up. Smoking prohibited on the premises. Staff complete daily inspections for illness. LPA did not observe prohibited child care items at this time. All electrical outlets were inaccessible. Firearms/weapons are not allowed or stored on premises. There are no bodies of water on the premises. The Center has the menu posted. Children have access to water while in the classrooms via drinking fountains.

Restrooms: There are two toilets in each school age classroom. LPA observed a section of the flooring behind one of the toilets in school age classroom B was starting to peel and bubble. The area was less than 12 inches, approximately. Per Administrator a work order was submitted last week. LPA advised the Center to ensure the work order is completed and the floor is repaired so the facility continues to be a clean, safe, sanitary and in good repair. LPA observed paper towel and soap dispensers available for the children. Additional restrooms available for the staff.
Kitchen: The facility has a self contained kitchen. The kitchen was inaccessible to the children via a key lock. Kitchen has a sink, refrigerator, a stove, and storage cabinets. The Center provides breakfast, lunch and one snack.
Outdoor: The Center has a large enclosed outdoor play space equipped with a large climber. The climbing structure was placed on cushioning material with turf placed over the top. The climbing structure was anchored to the ground. Zero bodies of water were observed. The outdoor play space is completely fenced and separate from the playground utilized by the infant and preschool component. Drinking water is readily available to the children when outside via drinking fountain.

During the inspection teacher child ratios were observed, and found to met the requirements. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.

Report continued on page three

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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: 08/08/2023

NARRATIVE

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Report continued from page two

Staff/Personnel Records
LPA reviewed five child records and five staff files during this inspection. Child files were complete and contained the required documentation. Based on LPA review, one of five staff files was missing documentation of the health screening and documentation of the required immunization's. LPA issued a technical advisory notice. In addition, based on LPAs review, five of five staff files reviewed did not contain documentation that the employees received the influenza vaccination or choose to decline the immunization. Based on LPA record review, a type B citation was issued, refer to LIC 809D. A staff member was on site who had current CPR/First Aid.

Facility Records

LPA and Facility representative reviewed the LIC 311A Records To Be Maintained At The Facility.
The facility has met the required Lead testing requirements.

Health Related Services
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
Postings:
The following were observed posted as required: facility license, Personal Rights (LIC613A), Parent’s Rights Poster (PUB 393), car seat law (PUB 269), emergency disaster plan.
Topics Discussed:
Any duly authorized officer, employee, or agent of the Department shall, upon presentation of proper identification, shall inspect the facility. The Director shall permit the Department to inspect the center, and to privately interview children or staff, to determine compliance with or to prevent violations of laws or regulations, also enter and inspect any place providing personal care, supervision and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation.
Continued page four

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC809 (FAS) - (06/04)

Page: 8 of 9

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: 08/08/2023

NARRATIVE

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Report continued from page three
Facility representative was advised of the requirement to report Unusual Incidents. Facility representative informed to utilize the Unusual Incident Report/Injury Report LIC624 when submitting the report to the department (email address: www.unusualincidentreport@dss.ca.gov). A report shall be made to the department by telephone or fax during the department's normal business hours before the close of the next working day following the occurrence during the operation of center. In addition, a written report shall be submitted to the department within seven days following the occurrence of any events specified above. The On-Duty Worker is available for questions at (661) 202-3318 Monday through Friday 8am-5pm.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important license related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to insectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
Based on LPA observations and record review one type B citation was issued, two technical violations were issued and two technical assistances were issued.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with the facility representative Jennifer Johnson.

SUPERVISOR'S NAME: Lady King	TELEPHONE: (310) 568-1824
LICENSING EVALUATOR NAME: Kendal Zirbes	TELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC809 (FAS) - (06/04)

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