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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215587
Report Date: 09/18/2024
Date Signed: 09/18/2024 01:34:08 PM

Document Has Been Signed on 09/18/2024 01:34 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:KINDERCARE LEARNING CENTER WLVFACILITY NUMBER:
566215587
ADMINISTRATOR/
DIRECTOR:		SARAH HUTSONFACILITY TYPE:
830
ADDRESS:917 HAMPSHIRE ROADTELEPHONE:
(805) 494-5152
CITY:WESTLAKE VILLAGESTATE: CAZIP CODE:
91361
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 21DATE:
09/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:17 AM
MET WITH:Cruz DominguezTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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On 09/18/24, Licensing Program Analyst (LPA) Veronica Diaz conducted a Case management incident inspection at the Child Care Center (CCC), for the purpose of following up on the report of an Unusual Incident Report (UIR) received by the Department on 09/13/24. Specifically, the incident involved a child in care, C1, fell back on a chair and hit their head needing medical attention. LPA met with Director Cruz Dominguez discuss the purpose of today's inspection. LPA notes 21 children and 7 staff were present during inspection.

Director Cruz Dominguez informed Licensing, C1 was eating his snack and leaned back in their chair and hit their head on the bottom of the self. S2 was passing out morning snacks when S1 and S2 witnessed C1 fall back hitting his head on a self. S2 stated it happened so fast that they noticed C1 rocking in their chair and was about to ask them to stop when they just fell back. S2 stated they immediately picked up C1 and grabbed a paper towel and placed it behind C1 head and applied pressure due to visible bleeding. Staff 2 stated that they notice a large amount of blood and asked S1 to call director. Director took C1 out of the classroom and called 911 and parent. Director stated paramedics arrived and stated that it was okay to wait for parents to arrive and the parents will be able to transport C1 for medical treatment. Director stated that parent arrived about 5 minutes after notifying them and transported C1 by car to the hospital were C1 received medical treatment. Medical report was giving to facility and LPA obtained a copy. Director stated C1 has behavioral issues and sees a Behavior Therapist twice a week. Director stated that the CCC and C1 parents are working together to provided adequate assistance to C1.

CONT 809-C
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: KINDERCARE LEARNING CENTER WLV
FACILITY NUMBER: 566215587
VISIT DATE: 09/18/2024
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Director reported CCC has removed the self and assessed the classroom to avoid further incidents from happening.

Director reported within the 24 hours that is required by licensing. LPA observed the classroom where the incident occurred.

Based information obtained and LPA observation there was adequate supervision. California Code of Regulations, Title 22, Division 12 or Health and Safety Code, no deficiencies are being sited today

Exit interview and review of report was conducted with Director Cruz Domingez Notice of Site visit was provided and must remain posted for the next 30 days.

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
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