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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005945
Report Date: 06/29/2023
Date Signed: 06/29/2023 01:28:54 PM


Document Has Been Signed on 06/29/2023 01:28 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: 42DATE:
06/29/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:56 AM
MET WITH:Jennifer HollandsworthTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management-Incident inspection. This inspection is regarding an incident that took place on June 20, 2023. LPA met with Director Jennifer Hollandsworth who assisted with the inspection.

LPA conducted interviews with four staff and the Director. LPA also observed the classroom to 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 possible minor injury to the face/forehead. Staff indicated that they did not witness child #1 sustain an injury at the facility and child #1 did not exhibit any signs of being uncomfortable or injured. Staff indicated that child #1 resumed normal activities throughout the day.

Note: The child returned to school the next day without any instructions regarding restriction. Director indicated that the child may have been observed by medical staff however no paperwork was provided. The facility followed the required protocol in terms of "reporting requirements" as the June 20, 2023 incident was reported to Child Care Licensing within the required 24 hours. LPA informed Director that more interviews may be conducted at a later date.

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: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023
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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