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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415906
Report Date: 04/20/2021
Date Signed: 04/20/2021 11:27:20 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013415906
ADMINISTRATOR:MA, YVONNEFACILITY TYPE:
850
ADDRESS:32710 FALCON DRIVETELEPHONE:
(510) 324-3569
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY:108CENSUS: 64DATE:
04/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tanya TrejoTIME COMPLETED:
11:45 AM
NARRATIVE
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On 04/20/2021 Licensing Program Analyst (LPA) Jaylena Miller arrived for an unannounced case management inspection and met with acting director S1 and explained the purpose of today’s inspection.

On 04/12/2021 S1 called in an unusual incident to the desk duty analyst that pre-school B teacher (S2) was transitioning her class outside when C1 went to the bathroom and S2 shut the door before doing a headcount to make sure all the kids transitioned properly. C1 was in the bathroom at the time and was left unsupervised for 2-3 minutes prior to being found by S2. S2 notified S1 and C1s parents immediately. Per California Code of Regulations Title 22, Division 12 Chapter 1 Article 06 section 101229(a)(1) Responsibility for Providing Care and Supervision was not met. Based on information obtained, it is concluded that S2 did not have complete physical and visual supervision of C1 when she transitioned the class outside. Due to absence of supervision, it poses an immediate risk to the health and safety of children in care. A Type A deficiency is cited and immediate civil penalty of $500 assessed on page 809-D and a non-compliance conference will be scheduled with the Licensing Program Manager and Regional Manager at a later date.

Due to the issuance of a Type A Citation during today's inspection, a copy of this Licensing Report must be posted in the facility and given to each existing parent by the end of today or next day child is in care. Report also has to be provided to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file.

A notice of site visit was given and must be posted for 30 days and this report shall remain on file for 3 years. Exit interview conducted with acting director, a copy of this report, appeals rights, the deficiency and plan of correction were given, and signature acknowledges receipt.

Please see LIC 809-D for deficiency
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena MillerTELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013415906
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/20/2021
Section Cited

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101229(a)(1) Responsibility for Providing Care & Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs (1) No child(ren) shall be left without the supervision of a teacher at any time [...] Supervision shall include visual observation. This requirement is not met as evidenced by:
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Based on observation, interviews and record review, S2 (teacher) did not ensure C1 was accounted for prior to going outside and was unsupervised for 2-3 minutes. This poses an immediate risk to the health and safety of children in care. An Immediate Civil penalty of $500 assessed.
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Due to the issuance of a Type A Citation during today's inspection, a copy of this Licensing Report must be posted in the facility and given to each existing parent by the end of today or next day child is in care. This report also must be provided to the parent of children who are enrolled over the next 12 months. In addition, a copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports must be signed by each parent and kept in each child's file. A civil penalty of $ 500 was assessed and issued during today’s inspection. A non-compliance conference will be scheduled at a later date.

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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: Jaylena MillerTELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2021
LIC809 (FAS) - (06/04)
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