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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566209103
Report Date: 12/13/2022
Date Signed: 12/13/2022 02:52:03 PM


Document Has Been Signed on 12/13/2022 02:52 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:KINDERCARE LEARNING CENTER VENFACILITY NUMBER:
566209103
ADMINISTRATOR:VIRGIE AGUILARFACILITY TYPE:
830
ADDRESS:1197 SOUTH VICTORIA AVENUETELEPHONE:
(805) 339-9363
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY:32CENSUS: 8DATE:
12/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Alice BurrisTIME COMPLETED:
03:06 PM
NARRATIVE
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On 12/13/2022 at 1:30 PM, Licensing Program Analyst (LPA) Austin Rios conducted an unannounced Case Management inspection. LPA met with facility assistant Director Alice Burris and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 8 children in care at the time of the inspection.

On 11/17/2022, Director self reported that on November 17, 2022 around 11:30 AM, C1 was left unattended in the class closet. Director indicated children were transitioning from outside to inside the classroom when S1 proceeded to change a child's diaper. S1 opened closet to grab a book for a child and staff was moving quickly and forgot to check after closing the closet. C1 entered the closet and S1 inadvertently closed the closet with C1 inside. S1 later then opened closet door to put purse away and found C1 sitting on the closet floor playing with a toy. The Director estimated C1 was unattended in the closet for under two minutes. The closet has an automatic light and the light was on when child was inside. Director also noted C1 was not injured or harmed while being left unattended in the closet. Parent was notified of the incident immediately. Director reminded all staff of child supervision records for name to face recognition. Staff was coached on supervision when entering the closet and given a copy of child supervision reading material from quality foundations book and went over that material together with staff.

Today, LPA inspected the area and observed where the incident took place. The Director reported the incident and submitted the incident report to the Department as required. LPA advised the director that the incident was an absence of supervision.

The following CCR, Title 22, Division 12 Type A regulation was cited 101229(a)(1) Responsibility for Providing Care and Supervision
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022
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 12/13/2022 02:52 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
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: KINDERCARE LEARNING CENTER VEN
FACILITY NUMBER: 566209103

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2022
Section Cited

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101229(a)(1): Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision ...to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher ... visual observation.
This requirement is not met as evidenced by:
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Director will submit a written plan of correction stating measures to be taken in order to be in compliance with Title 22 Regulations and avoid any children left unattended by 12/20/2022.
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Based on LPA's observation during the inspection tour and director self-reporting the incident, Child #1 was left unsupervised inside the class closet. This is an immediate risk to the health and safety of the children in the facility.
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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: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022
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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KINDERCARE LEARNING CENTER VEN
FACILITY NUMBER: 566209103
VISIT DATE: 12/13/2022
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Failure to Post the Notice of Site Visit for 30 days may result in a $100.00 Civil Penalty.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.81

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin RiosTELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3