304270397-5-11-2022-06-CC-NKTN-CEBUB9-20220511152558

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270397
Report Date: 05/11/2022
Date Signed: 05/11/2022 03:26:05 PM

Document Has Been Signed on 05/11/2022 03:26 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	KINDERCARE LEARNING CENTER		FACILITY NUMBER:	304270397
ADMINISTRATOR:	JASMIN CANALES		FACILITY TYPE:	850
ADDRESS:	4601 BEACH BLVD.		TELEPHONE:	(714) 994-5610
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90621
CAPACITY: 104	TOTAL ENROLLED CHILDREN: 104	CENSUS: 56	DATE:	05/11/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jasmin Canales, Director		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 05/11/2022, Licensing Program Analyst (LPA) Nguyen Tran conducted a subsequence case management inspection to follow up on a self-report unusual incident that was submitted to Community Care Licensing Regional Office on 04/07/2022. It was reported by Jasmin Canales, Director that on 04/06/22, at 10:28am, Staff #1 (S1) with 12 preschool children on the playground started transitioning to room # 5 at 10:23 am. She left child #1 (C1) on the playground. Staff #2 (S2), from next door room # 6, opened her door to take her children out at 10:28 am. S2 saw C1 on the play structure on the playground unsupervised. S2 reported to Director who came to the class to check on the class. When Director came to the playground to check on C1. S1 opened her door to look for C1. According to Director, the child must have been unsupervised for 2 minutes. During today's inspection a tour of the facility was conducted. There were 56 preschool children and 7 staff in 4 different classrooms. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. During today's inspection, LPA interviewed staff members. During the interviews, all interviewed staff provided consistent statements regarding the incident as followed. Director stated, she was informed by S2, who were in classroom # 6, that C1 was left alone in the playground. When Director came to assist C1, S1 opened the classroom #5’s door and was looking for C1. S2 disclosed that when S2 was getting the children in classroom # 6 to be ready to transition into the playground, S2 heard knocking on the door. When S2 opened the classroom door, S2 discovered C1 was outside in the playground without supervision. S2 immediately informed Director at 10:28am. Director immediately came to assist C1, and at the same time, S1 opened the classroom # 5’s door to look for C1. When interviewed, S1 admitted that at 10:25am S1 completed the transitioning name-to-face supervision procedure but did not notice that S1 missed counting C1. As soon as transitioning into classroom #5, S1 changed diaper for another child, and that was when S1 realized C1 was not in the classroom. S1 immediate opened the classroom door to look for C1 on the playground. S1 saw Director and S2 with C1 on the playground, and Director guided C1 into the classroom #5. (Continue next page)

Rina Lopez
Nguyen K Tran
	DATE: 05/11/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: KINDERCARE LEARNING CENTER	FACILITY NUMBER: 304270397
	VISIT DATE: 05/11/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Page 2 of Report)

Based on LPA’s interviews conducted with staff, the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101229(a)(1) Responsibility for Providing Care and Supervision. The deficiency is being cited on the attached 809D and an immediate civil penalty was assessed.

Due to the Type A violation cited today, the Director shall post, and provide copies, of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. The Director is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. In addition, the Director shall immediately post upon receipt the Proof of Correction for 30 consecutive days.

Appeal Rights were explained. The Director was provided a copy of appeal rights (LIC 9058 01/16) 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. First level appeals should be sent to the regional manager to the address listed above. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director.

(End of Report)

SUPERVISOR'S NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 05/11/2022 03:26 PM - It Cannot Be Edited

Created By: Nguyen K Tran On 05/11/2022 at 01:54 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: 304270397
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/11/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/11/2022 Section Cited	1 2 3 4 5 6 7	101229 Responsibility for Providing Care and Supervision. (a) The licensee shall provide care and supervision...(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	Based on interviews, staff did not provide supervision for one child within two minutes as children were transitioning inside of the classroom. This poses an immediate risk to the safety of children in care.	8 9 10 11 12 13 14	Director provided copies of the supervsion trainings on this date.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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:

Rina Lopez

LICENSING EVALUATOR NAME:

Nguyen K Tran

LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3