<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403566
Report Date: 03/04/2024
Date Signed: 03/20/2024 02:20:34 PM


Document Has Been Signed on 03/20/2024 02:20 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/20/2024 12:55 PM

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

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
Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted a case management inspection at KinderCare Learning Center. LPA met with Director Genesis Benitez and was allowed access to the facility. LPA stated purpose of the inspection was to follow-up on a self-reported Unusual Incident Report (UIR) that happened on 02/27/2024 at the center. The investigation included an inspection of the facility where the incident occurred, facility records, and confidential interviews with staff members. LPA was provided a copy of the Child Supervision Record (Name-To-Face Transition Sheet).

During this visit, LPA observed 11 Pre-K children and 2 staff members providing care and supervision.
Based on the information gathered, the incident happened on 02/27/2024 at around 11:45 A.M when the pre-k class was transitioning for an outdoor play. There are twenty-three children present and two staff members (Staff 1 and Assistant Director) providing care and supervision to children. Staff 1 was calling each child’s name using the Child Supervision Record while the Assistant Director was watching the children. When every child was outside, child 1 went inside the classroom unnoticed. Child 1 went to the pre-k bathroom, turn off the lights, and hide from the staff members. Staff members reinspected the classroom for any child that was left inside the classroom and found no one. Child was seen leaving the bathroom and was accompanied to the outdoor play area.

Additional information needed.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


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: 197403566
VISIT DATE: 03/04/2024
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
26
27
28
29
30
31
32
Document Link IconPg 2

A LIC 9213 Notice of Site Visit was left at facility and must be posted for 30 days. Failure to do so will result in an immediate civil penalty assessment of $100.00.

An exit interview was conducted, Appeal Rights and a copy of this report were provided to Director Genesis Benitez.result in an immediate civil penalty assessment of $100.00.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Joselito DelMundoTELEPHONE: (661) 202-3491
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2