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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414001398
Report Date: 05/20/2021
Date Signed: 06/01/2021 04:24:00 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/26/2021 and conducted by Evaluator April Cowan
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20210426160759
FACILITY NAME:KINDERCARE LEARNING CENTER LLC (PS)FACILITY NUMBER:
414001398
ADMINISTRATOR:SCHMALZ, DINA (MIMI)FACILITY TYPE:
850
ADDRESS:1350 WAYNE WAYTELEPHONE:
(650) 577-0257
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:70CENSUS: DATE:
05/20/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Dina SchmalzTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not provide the needs of day-care child after an injury

Facility did not follow injury protocol for injured child in care
INVESTIGATION FINDINGS:
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 THIS IS AN AMENDED REPORT

On 5/20/19 at 2:30 PM, Licensing Program Analyst (LPA) Cowan met with site director for an unannounced subsequent complaint inspection. The purpose of the inspection was to deliver findings, and the purpose of the inspection was explained. Due to Covid-19 State Emergency, the inspection is conducted via telephone call.

During the course of investigation, interviews were conducted with director and staff, and records were reviewed. There was no proof that care was provided for injured child. The facility failed to deliver an incident report to the parents that describes the care of the injured child.

Based on interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegations are founded to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.

This report is emailed to director with a request for reply demonstrating receipt.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 05-CC-20210426160759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: KINDERCARE LEARNING CENTER LLC (PS)
FACILITY NUMBER: 414001398
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2021
Section Cited
CCR
101223(a)(8)
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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (8) To receive or reject medical care, or health-related services, except for minors for whom a guardian, conservator or other legal authority has been appointed. This requirement is not met as evidenced by:

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Director agrees train staff on caring for injured children in care. Director agrees to email LPA a copy of meeting agendy and attendee by 6/18/21.
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Based on interviews and record review, the facility staff did not ensure that child was cared for by applying ice to the forehead after an injury.
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Type B
06/18/2021
Section Cited
CCR
101221(b)(9)
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101221 Child's Records
(b) Each record shall contain information including, but not limited to, the following: (9) Record of any illness or injury requiring treatment by a physician or dentist and for which the center provided assistance to the child in meeting his/her necessary medical or dental needs. This requirement was not met as evidenced by:
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Director agrees train staff incident documentation and reporting of injured children in care. Director agrees to email LPA a copy of meeting agendy and attendee by 6/18/21.
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Based on interviews and record review, the facility staff did not ensure injured child's parent received notification of care provided.
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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: April CowanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2