Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403594
Report Date: 10/06/2015
Date Signed 10/06/2015 03:27:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
197403594
ADMINISTRATOR:ANA CASTELLANOSFACILITY TYPE:
830
ADDRESS:17730 RINALDITELEPHONE:
8183638442
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:24CENSUS: 6DATE:
10/06/2015
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Thania GarciaTIME COMPLETED:
03:30 PM
NARRATIVE
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Margarit Sislyan, Licensing Program Analyst (LPA) arrived to the facility to investigate the unusual incident occurred on 7/20/2015. Infant child pulled herself up from the feeding tray chair, when she lost her balance, she fell backwards. The chair fell on her. The child got injuries: bump on her head and cut on her gum.

LPA Sislyan met with Thania Garcia and toured the infant rooms. LPA observed the feeding tray chair. LPA observed that the feeding tray chair couldn’t support the child to pull her up. Per interviews and review of teachers’ attendance sheets the ratio was in compliance.

LPA reviewed documentation relevant to the incident and interviewed infant teachers.

Based on LPA’s observation and interviews’ conducted the facility failed to provide appropriate supervision to prevent the child from fall.

The child was not supervised properly and got injured.

Facility was cited Type A deficiency, according to California Code of Regulations Title 22 See 9099D report for deficiencies. A copy of this report must be copied and given to all parents and to the parents of any child enrolling within the next 12 months.
Licensee is to post notice of Site Visit for 30 Days, failure to do so will result in $100 immediate civil penalty.
Exit Interview conducted
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2015
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
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 197403594
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/06/2015
Section Cited
101229(a)(1)
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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
Facility failed to provide appropriate supervision to prevent the child from fall.
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No child) shall be left without the supervision, including visual observation, of a teacher at any time.

POC date 10/06/15
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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: Mary RuizTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2015
LIC809 (FAS) - (06/04)
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