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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561700572
Report Date: 09/18/2024
Date Signed: 09/18/2024 01:32:38 PM


Document Has Been Signed on 09/18/2024 01:32 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:KINDERCARE LEARNING CENTER WLVFACILITY NUMBER:
561700572
ADMINISTRATOR:SARAH HUTSONFACILITY TYPE:
850
ADDRESS:917 HAMPSHIRE RDTELEPHONE:
(805) 495-0851
CITY:WESTLAKE VILLAGESTATE: CAZIP CODE:
91361
CAPACITY:90CENSUS: 29DATE:
09/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cruz DominguezTIME COMPLETED:
11:15 AM
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On 09/18/24, Licensing Program Analyst (LPA) Veronica Diaz conducted a Case management incident inspection at the Child Care Center (CCC), for the purpose of following up on the report of an Unusual Incident Report (UIR) received by the Department on 9/13/24. Specifically, the incident involved a child in care, C1, fell causing C1 to need medical attention. LPA met with Director Cruz Dominguez discuss the purpose of today's inspection. LPA notes 29 children and 3 staff were present during inspection.

Director Cruz Domingez informed Licensing, C1 was observed going up a hill that is assessable to children and asked C1 to come down slowly. C1 was walking back down the hill and fell Director and Staff 1 both witnessed C1 fall. Director approached C1 to help them up and C1 was crying and stated my leg hurts. Director then carried C1 to the bench and observed C1. Director applied Ice and assessed C1 leg. Director stated there was no visible signs of medical attention needed. Director stated that they called parents immediately after the incident and requested for pick up and possible medical attention. Director stated that C1 sibling C2 is also attending the preschool and both C1 and C2 are still enrolled, However C1 return date is tentative November 17,2024 C2 is still attending. Facility was unable to obtain medical records at this time. Director stated that they requested the medical report and doctors note to put in C1 records but has not been provided at this time. LPA reviewed C1 records and did observer an incident report.

Director reported within the 24 hours that is required by licensing. LPA observed the location near the play yard where the incident happened.

Based information obtained and LPA observation there was adequate supervision. California Code of Regulations, Title 22, Division 12 or Health and Safety Code, no deficiencies are being sited today

Exit interview and review of report was conducted with Director Cruz Domingez Notice of Site visit was provided and must remain posted for the next 30 days.

SUPERVISOR'S NAME: Lissete GonzalezTELEPHONE: (805) -56-0400
LICENSING EVALUATOR NAME: Veronica DiazTELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
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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