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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005945
Report Date: 08/30/2023
Date Signed: 08/30/2023 03:47:35 PM


Document Has Been Signed on 08/30/2023 03:47 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
198005945
ADMINISTRATOR:JENNIFER HOLLANDSWORTHFACILITY TYPE:
830
ADDRESS:5251 E. LAS LOMASTELEPHONE:
(562) 961-8882
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:56CENSUS: 40DATE:
08/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Jennifer HollandsworthTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management-Incident inspection. This inspection is regarding an injury incident that took place on August 17, 2023. LPA met with Director Jennifer Hollandsworth who assisted with the inspection.

LPA conducted interviews with staff #1 and the Director. LPA also observed a photo of child #1's injury. LPA observed the classroom appear clean, safe and free of uncommon hazards for an infant child. LPA received disclosure and a written incident report indicating child #1 sustained a very minor injury to the nail area of the finger. The injury took place when child #1 placed the finger in a display board. Staff #1 witnessed the incident and provided some first aid to comfort the child. LPA received disclosure that the facility received no information that child #1's injury required professional medical attention (child returned to school the next day). LPA observed the display board and advised Director to provide extra care and supervision around that area and/or remove or alter display board.

Note: The child did not have to receive professional medical attention and returned to school the next day without any restrictions. The facility followed the required protocol in terms of "reporting requirements" as the August 17, 2023 incident was reported to Child Care Licensing within the required 24 hours. Staff also provided first aid and contacted parents immediately.

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. This report will be sent to the Licensee via email with a read receipt to confirm receipt of the report. Exit interview was conducted with Director Jennifer Hollandsworth.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2023
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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