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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415775
Report Date: 01/17/2024
Date Signed: 01/17/2024 02:44:18 PM


Document Has Been Signed on 01/17/2024 02:44 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013415775
ADMINISTRATOR:SCOTT KINSERFACILITY TYPE:
830
ADDRESS:11925 AMADOR VALLEY COURTTELEPHONE:
(925) 875-0400
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY:36CENSUS: 21DATE:
01/17/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Assistant director, Jennifer ChuTIME COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jyoti Saini met with Assistant Director Jennifer Chu to conduct a Case Management inspection for the Lead Testing results at this facility. In addition to the Assistant Director, 21 children, and five staff members are present today. The facility operates Monday - Friday from 7:00 am to 6:00 pm.
During the inspection, It was concluded that three outlets exceeded the Action Level established by the state for exposure, and all three Faucets are located within an unoccupied classroom ( toddler 2). LPA obtained photos of the faucets that have exceeded 5.5 ppb. LPA discussed a Plan of Correction, and the facility has submitted the documentation for the post-testing requirements.

See the attached deficiency LIC 809-D

A notice of site visit was given and must remain posted for 30 days.

Appeal Rights provided.

An exit interview was conducted, and the report was reviewed with the assistant Director, Jennifer Chu.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024
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


Document Has Been Signed on 01/17/2024 02:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013415775

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2024
Section Cited

101700.3(b)(1)

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101700.3(b)(1)A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement is not met, as evidenced by:
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All three outlets currently fall under the unoccupied room. The facility is in the process of rescheduling and retesting the water faucets.
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The licensee failed to maintain a lead value at or below the Action Level for water lead testing with values of 5.5 ppb or greater for outlets L, M, and N. Water testing results identified with Action Level Exceedance as defined in WD section 101700.3. are not deemed safe to drink.
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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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2