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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403566
Report Date: 05/25/2023
Date Signed: 05/25/2023 04:59:14 PM

Document Has Been Signed on 05/25/2023 04:59 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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
197403566
ADMINISTRATOR:GENESIS BENITEZFACILITY TYPE:
850
ADDRESS:44400 FOXTONTELEPHONE:
(661) 948-1767
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 15DATE:
05/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Genesis BenitezTIME COMPLETED:
05:00 PM
NARRATIVE
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On 05/25/2023 at 12:48 P.M., Licensing Program Analyst (LPA) Joselito L. Del Mundo conducted a case management inspection at KinderCare Learning Center. LPA met with Director Genesis Benitez. LPA stated purpose of the inspection was to follow-up on a self-reported Unusual Incident Report (UIR) that happened on 05/22/2023 about two children at the center. LPA observed 24 children and 2 staff.

Description of the incident: The incident indicates that two pre-kindergarten children (two boys) were using the same toilet bowl inside the bathroom during lunchtime and were playing together.

During the inspection, LPA interviewed 3 teachers and 2 children.

Based on the information gathered, while teacher #1 was talking to a parent of another child over the phone and teacher #2 was serving a family style dining, child #1 asked permission from teacher # 1 to use the bathroom. Teacher #1 and #2 were not aware that child #2 followed child #1 inside the restroom and did not have visual observation on child #2. Teacher #1 stated that it is their center policy for a child to ask permission when using the bathroom and child has to wait outside the bathroom. A teacher from toddler classroom, Teacher #3 saw what child #1 and #2 were doing inside the bathroom.

During the interview, child #1 stated that he and child #2 were playing pee pee games inside the bathroom. However, child #2 denied that such things happened inside the bathroom and that child #2 did not play any games with other child.

Per Title 22, section 101229 Responsibility for Providing Care and Supervision, (a) The licensee shall
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 197403566
VISIT DATE: 05/25/2023
NARRATIVE
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Pg 2

provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. A Type A deficiency will be cited for lack of supervision on child #2.

Upon receipt of a Type A deficiency licensee shall post the report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report to parents/guardians of children in care at the facility. This report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. If these requirements are not met, civil penalties will be assessed.

LPA advised Director Benitez that teachers or staff shall always provide supervision to children in care.



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.

Exit interview was conducted, Appeal Rights and a copy of this report were provided to Director Genesis Benitez.
SUPERVISORS NAME: Lady King
LICENSING EVALUATOR NAME: Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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Document Has Been Signed on 05/25/2023 04:59 PM - It Cannot Be Edited


Created By: Joselito DelMundo On 05/25/2023 at 04:39 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 197403566

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/26/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.

This requirement is not met as evidenced by:
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Director will review the operating procedure and other protocols to staff when a child wants to use the bathroom.

Director shall provide training to staff under section 101229(a)(1) and provide proof of the training to the department.
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Child #2 was left without the direct supervision and visual observation of facility staff which posed an immediate Health, Safety or Personal Rights risk to persons in care.
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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:Lady King
LICENSING EVALUATOR NAME:Joselito DelMundo
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023


LIC809 (FAS) - (06/04)
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