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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005944
Report Date: 05/19/2023
Date Signed: 05/19/2023 09:43:33 AM


Document Has Been Signed on 05/19/2023 09:43 AM - 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198005944
ADMINISTRATOR:JENNIFER HOLLANDSWORTHFACILITY TYPE:
850
ADDRESS:5251 E. LAS LOMASTELEPHONE:
(562) 961-8882
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:105CENSUS: 52DATE:
05/19/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jennifer HollandsworthTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced case management Lead Testing exceedance inspection on May 19, 2023. LPA Birks met with Director Jennifer Hollandsworth who guided LPA on a tour of the facility. There were 52 children and 11 staff present during the inspection.

The purpose of today's inspection is to review and discuss the January 5, 2023 water lead test results received on March 23, 2023. The results indicate that one water source had action level exceedance of lead. The water faucets in room 3 and the toddler room had a lead result of 7.69 and 7.52. Note: The toddler room was previously a break room and has never been in use. Director Hollandsworth informed LPA Birks that the the two water fountains have been removed. Director indicated the room uses water bottles and water pitchers in rooms and has other sources in the facility (which were tested and have passing water levels).

LPA Birks took pictures of the water fountain areas where the fountains were removed. A deficiency was cited as the water fountain in room 3 was accessible prior to testing. This is also to ensure that the water fixture area noted will not be used as a drinking source or food preparation source for children (unless the facility submits passing levels).

The deficiency listed on the following page was observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. The deficiency was cleared on April 4th, 2023 as the accessible fountains were completely removed to protect the children’s health & safety. Therefore, the citation is cleared.

The Notice of Site Visit (LIC 9213 –must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview conducted with Director Jennifer Hollandsworth and a copy of Appeal Rights (LIC 9058) was discussed.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2023
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 05/19/2023 09:43 AM - 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198005944

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/22/2023
Section Cited
CCR
101700.3(b)(1)

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(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level.

(1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedence
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LPA observed photos and today's visual evidence that the water fountains were completely removed. Therefore the item will be cleared as of 4/4/2023 email.
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This requirement was not met as evidence by record review. Lead test results revealed one accessible water source (and one future accessible) had an action level exceedence. This is a potential risk to the health and safety of the children in care. LPA Birks observed the water faucets were removed.
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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: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2023
LIC809 (FAS) - (06/04)
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