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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005945
Report Date: 09/08/2023
Date Signed: 09/08/2023 02:29:08 PM

Document Has Been Signed on 09/08/2023 02:29 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: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 17DATE:
09/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Regina Ramirez/Monica GonzalezTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management-Incident inspection. This inspection is regarding a personal rights incident that took place on September 6, 2023. LPA met with Associated Directors Regina Ramirez and Monica Gonzalez who were assisting with facility.

At approximately 12:15pm LPA conducted an interview with staff #1 and Director Monica Gonzalez. The facility submitted to the department a September 6, 2023 Unusual Incident Report indicating that a social worker arrived at the facility at approximately 12:25pm to pick up child #2. During the pick up, child #1 was mistaken for child #2 and as a result, staff released child #1 to a social worker (who left the facility for approximately 10 minutes). The facility then contacted the social worker and child #1 was returned to the facility immediately. Note: Disclosure received corroborates the incident report submitted.

Note: Child #1 was returned safely to the facility. However, the facility is cited for Personal Rights (immediate risk to children in care). This is due to a failure in protocols which could have prevented child #1 from being misidentified as child #2. LPA informed Director Gonzalez that protocols must be implemented to provide safe and healthful accommodations to children in care. Director Gonzalez informed LPA that the facility will provide an all staff training on drop off and pick procedures and submit evidence of training to Child Care Licensing.

The facility followed the required protocol in terms of "reporting requirements" as the September 6, 2023 incident was reported to Child Care Licensing within the required 24 hours. The facility also followed up with a written report with seven (7) days.
A copy of this report must be provided to the parent or guardian of every child and (including any newly enrolled children) for the next 12 months. The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent/guardian). Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) form. Continued
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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 09/08/2023 02:29 PM - It Cannot Be Edited


Created By: Warren Birks On 09/08/2023 at 01:27 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
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198005945

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/08/2023
Section Cited
CCR
101216.1

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Personal Rights: (a) The licensee shall ensure that each child is accorded the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director Gonzalez indicated that the center will have a refresh training in protocols for child drop off and child pick up. The facility will submit to Licensing evidence of completed training for all staff.
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This requirement was not met as evidenced by: LPA received a 9/6/2023 Incident Report and disclosure that child #1 was mistaken for child #2 and as a result allowed to exit the facility with a social worker for approximately 10 minutes before staff had the Social return the child. This is an immediate risk to children 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:Karen Chambers
LICENSING EVALUATOR NAME:Warren Birks
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2023


LIC809 (FAS) - (06/04)
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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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 198005945
VISIT DATE: 09/08/2023
NARRATIVE
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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 Monica Gonzalez.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC809 (FAS) - (06/04)
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