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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197403508
Report Date: 11/02/2023
Date Signed: 11/02/2023 02:02:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/26/2023 and conducted by Evaluator Carol Heath
COMPLAINT CONTROL NUMBER: 12-CC-20230926123819
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
197403508
ADMINISTRATOR:PILAFAS, LORETTAFACILITY TYPE:
850
ADDRESS:43536 22ND STREET WESTTELEPHONE:
(661) 948-3570
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:60CENSUS: 42DATE:
11/02/2023
UNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Michelle MooreTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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2
3
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7
8
9
Personal Rights
Other
INVESTIGATION FINDINGS:
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12
13
On 11/02/2023, Licensing Program Analyst (LPA) Carol Heath conducted a follow-up complaint inspection of the KinderCare Child Care Center and met with the assistant director, Michelle Moore. The purpose of the inspection was to deliver the findings for the above complaint allegations.
During the course of the investigation of this complaint, LPA Heath conducted interviews with the director, teachers, and other related parties. Based on interviews, it was determined that the teaching staff did not notify the child's parents of the incident or provide first aid to the child after the incident happened in the facility.
Based on the information obtained and the statement from the teacher, there is a preponderance of evidence to prove that the teacher did not notify the parent and provide the first aid. Therefore, the above allegation is Substantiated.

Appeal Rights were provided and discussed with the Licensee and 2 deficiencies were cited.
Exit interview conducted and the report was reviewed with the assistant director, Michelle Moore.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 12-CC-20230926123819
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 197403508
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2023
Section Cited
CCR
101226(a)
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7
101226 (a) Health Related Service: The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch... This requirement is not meet as evidenced by:
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7
The facility will have a staff meeting to go through title 22 Health-Related Services and email the sign in sheet with LPA.
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12
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14
Based on interview, the facility staff did not call child’s parent when the incident happened, which poses a Potential Health, Safety, or Personal Rights risk to children in care.
8
9
10
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12
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14
Type B
11/10/2023
Section Cited
CCR
101226(a)(1)
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2
3
4
5
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7
101226 (a)(2) Health Related Service: In the case of less serious injuries including, but not limited to, minor cuts, scratches and bites from other children requiring assessment and/or administration of first aid by staff...This requirement is not meet as evidenced by:
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The facility will have a staff meeting to go through title 22 Health-Related Services and email the sign in sheet with LPA.
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14
Based on the interview, the facility staff did not provide the child first aid (ice pack) when the incident happened, which poses a Potential Health, Safety, or Personal Rights risk to children in care.
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9
10
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12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2