364840920-5-27-2020-09-CC-SRON-BQ23GX-20200527181504

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364840920
Report Date: 05/27/2020
Date Signed: 05/27/2020 06:15:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	364840920
ADMINISTRATOR:	BIERMAN, TRACY		FACILITY TYPE:	840
ADDRESS:	33788 YUCAIPA BLVD		TELEPHONE:	(909) 797-4713
CITY:	YUCAIPA	STATE: CA	ZIP CODE:	92399
CAPACITY:	36	CENSUS: 24	DATE:	05/27/2020
TYPE OF VISIT:	Case Management - Incident	ANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Tracy Bierman, Director		TIME COMPLETED:	04:00 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	Due to COVID-19, Licensing Program Analyst (LPA) Sharleen Robinson conducted a Tele-inspection with Director Tracy Bierman to conduct a Case Management follow up Tele-inspection regarding an unusual incident that occurred May 19, 2020. LPA Met with the Director via Skype. Per the Director there were 24 children in care. the Director toured LPA through the facility where the incident occurred. LPA conducted interviews and requested records. The Director reported that on about May 19, 2020 at approximately 4:50pm on the School Age playground, Child #1 was sliding down the sliding board, almost at the bottom of the sliding board ("placed their legs over the side of the sliding board"), when Child #2 who was unaware of Child #1 position on the sliding board, slid down the sliding board "bumped" into Child #1 causing Child#1 to fall landing on their left arm/elbow. The child's representative was notified, staff provided first aid to Child#1. The Director reported the incident to licensing. The child's representative took the child to seek medical attention, it was determined that Child#1 sustained a fracture to their left elbow. The Child returned to the facility May 25, 2020 without restrictions (per the Director). When the incident occurred, there were 8 children playing on the school age playground under the supervision of Staff #1. Per Staff #1 they were providing care to another child when they herd Child#1 cry. Staff #1 looked over and learned Child #1 slid down the sliding board; as the child was reaching the bottom of the sliding board, the child placed their legs over the side of the sliding board. Simultaneously Child#2 was at the top of the sliding board waiting to slide down, Child #2 slid down the Sliding board unaware that Child #1 was still on it and "bumped" into Child#1, causing Child#1 to fall forward landing on their Left arm/elbow. Staff #1 stated they could not get to the children in time to prevent the incident, however the children were in their direct view. See LIC809C for the remainder of the report.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Sharleen Robinson	TELEPHONE: (951) 233-7183
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2020

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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 364840920
	VISIT DATE: 05/27/2020

NARRATIVE

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During child(ren) interviews LPA learned that Child#1 was almost at the bottom of the sliding board when they placed their legs over the side of the sliding board, Child #2 "bumped" into Child#1 "on accident" causing Child#1 to fall off the sliding board landing on their left elbow. Staff #1 was standing near the sliding board when the incident occurred, after the incident occurred Staff #1 provided first aid to Child #1.

The Director conducted an in-service meeting with staff May 20, 2020 to discuss playground safety and supervision, children were also reminded of playground safety. Based on the information obtained during the Tele-Inspection, there appeared to be no violation of Title 22 Regulations pertaining to the reported incident.

No deficiencies. LPA Robinson provided the director with a copy of this report and notice of site visit via email with an electronic “read receipt” . The electronic read receipt of the emailed report acknowledges receipt of this report and Notice of Site Visit. A copy of this report was emailed to the Director during this Tele-inspection on May 27, 2020.

SUPERVISOR'S NAME: Kimberly Williams	TELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Sharleen Robinson	TELEPHONE: (951) 233-7183
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2020

LIC809 (FAS) - (06/04)

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