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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270686
Report Date: 09/30/2024
Date Signed: 09/30/2024 02:45:33 PM

Document Has Been Signed on 09/30/2024 02:45 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
304270686
ADMINISTRATOR/
DIRECTOR:		BROWN, BARBARAFACILITY TYPE:
830
ADDRESS:25189 BEACON HILL WAYTELEPHONE:
(949) 240-4004
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 15DATE:
09/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:DirectorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA), Mahnaz (Nancy) Malek conducted an onsite case management inspection for the purpose of investigating an incident that the facility self reported to our office on 9/24/2024. LPA met with director, Barbara Brown.
LPA took census. There were a total of 15 infants and toddlers with 5 staff in two different rooms. There were 5 awake infants with two staff in the infant room, and there were 10 toddlers with 3 staff in the Toddler Room. Two other infant/toddler rooms were not in use.

A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

According to the self incident report, on 9/23/2024, Staff # 1 was changing a 16 months old child's diaper on a diaper changing table. S1 had child stand up to pull the child's pants up, child fell forward hitting the head on the floor. Child had bumps on the forehead.

Today LPA interviewed the staff who were either involved or had information regarding the incident. S1, S2, S3, S4, and S5 were interviewed. S1 and S2 were in the room with 8 toddlers when the incident happened on 9/23/2024 around 3:00 pm.
S1 stated the following: I was changing the child's diaper after nap time. I was going to pull the child's pants up while child was standing on the diaper changing table. Child slipped on the disposable paper on the diaper changing table while grabbling to my shoulder. I tried to catch the child but I was not stable enough to catch the child. Child fell on the floor and got injured on the forehead, eyelid and lower lip.
Continued on page 2
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270686
VISIT DATE: 09/30/2024
NARRATIVE
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S2 was present in the room but did not observe the incident but heard a stump noise on the floor. S3 and S4 observed the child after the incident. LPA confirmed the process of changing diapers with staff in the toddler room today. They stated they are not supposed to have a child stand up on the diaper changing table. The director stated she has put a sign on the diaper changing not to let the staff have toddlers stand on the diaper changing table.

According to interviews, reviewing the written self report incident dated 9/23/2024, and Child Supervision Record (CSR), and admission of S1 the facility has violated the personal rights of children.

In the areas that were evaluated, the following deficiency of personal rights- section 101223(a)(2) was observed of the California Code of Regulations, Title 22, Division 12 on today's investigation regarding the incident. Please see next page LIC 809D for detail of deficiency.

Barbara Brown, the director was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00. LPA Malek informed the director, Barbara Brown that this report dated 9/30/2024 documents type A citation shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Malek informed the director, Barbara Brown to provide a copy of this licensing report dated 9/30/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. The director, Barbara Brown, was provided with a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. The exit interview was conducted with director, Barbara Brown.

End of report.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2024 02:45 PM - It Cannot Be Edited


Created By: Mahnaz Malek On 09/30/2024 at 01:25 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 304270686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/01/2024
Section Cited
CCR
101223(a)(2)

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Personal Rights- The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by S1's admission that a 16 months old child fell on the floor from the diaper changing
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The director agreed to review the process of changing diapers on the changing table in a safe way with staff. A review of discussion and understanding the process with the staff will be conducted.
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table while child standing to pull the pants up. Child slipped on the disposable paper on the diaper changing table while grabbling to S1's shoulder. S1 failed to catch the child to prevent the chilld of fallling. This is an immeiddiate risk to the health and stafety and personal rights of children in care.
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The statement with the staffs' signatures acknowledging the importance of a safe procedure for changing diaper on the changing table will be sent to our office by the due date of 10/1/2024.

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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:Thuy Ho
LICENSING EVALUATOR NAME:Mahnaz Malek
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2024


LIC809 (FAS) - (06/04)
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