<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566207886
Report Date: 03/21/2024
Date Signed: 03/21/2024 05:24:28 PM

Document Has Been Signed on 03/21/2024 05:24 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KINDERCARE LEARNING CENTER CAMFACILITY NUMBER:
566207886
ADMINISTRATOR:JENNIFER BREWERFACILITY TYPE:
830
ADDRESS:2360 PICKWICK DR.TELEPHONE:
(805) 445-8485
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 26DATE:
03/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Jennifer BrewerTIME COMPLETED:
05:40 PM
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 March 21, 2023 at 3:35 PM, Licensing Program Analyst (LPA) Laura Villanueva conducted an unannounced Case Management-Incident inspection. LPA met with director, Jennifer Brewer and advised the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 26 children in care at the time of the inspection and 7 staff.

Today's visit is to follow up on a self reported incident that occurred on 02/22/2024. Staff 1 accidentally identified the wrong infant (C1) and gave that child C2's bottle with breast milk. C1 took the bottle and potentially consumed approximately an ounce of milk. Staff 2 observed C1 had C2's bottle and quickly removed it. Staff 2 notified staff 1 that the bottle C1 was consuming was C2's bottl.e The 2 children drink breast milk. Both children's admission date was 02/05/2024 and are 4 days apart in age. The children's physical appearance is similar. Both children are blonde, blue eyed, and similar size. The 2 bottles were labeled with the child's name. C2's bottle is clear, long and has a white lid. The bottle is labeled with a white label that has the child's first and last name, amount of fluid, and labeled breast milk. C1's is a clear, shorter/wider, and has a purple lid. C1's bottle label is red with the child's name, amount of fluid, and labeled breast milk.

LPA interviewed Director, took Staff 2's written statement, and met the children involved. Staff 1 was off for the day and on vacation until 03/26/2024. LPA reviewed written LIC624 Unusual Incident/Injury Report with Director. Director stated that a Professional Development Day was held on 02/19/2024. Safe Bottle Feeding procedures were reviewed. The center implements the two step verification for bottle feeding. Step one is match child's name on the label to the child's face. Second step is confer with co-teacher that the correct bottle is to the correct child. In the incident, staff 1 mistook C1 for C2.

Director called parents within 5-10 minutes of the incident to inform. Director asked staff to observe the children for any kind of adverse reaction.. There was no reaction. C1's parents were called first and then C2's parents. C2's parents came to the center due to the bottle being the last one available. Parents
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KINDERCARE LEARNING CENTER CAM
FACILITY NUMBER: 566207886
VISIT DATE: 03/21/2024
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
chose to take him home to feed him. Director explained the incident to the parent in detail. Both families were understanding of incident. Children are still enrolled and no more incidents have occurred. Staff had documented coaching and reviewed the safe bottle feeding procedure. Staff is still employed at the center.

No deficiencies were cited. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
Exit interview conducted and report was reviewed with director, Jennifer Brewer.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Laura Villanueva
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2