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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001398
Report Date: 07/20/2021
Date Signed: 07/20/2021 03:16:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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
ADMINISTRATOR:SCHMALZ, DINA (MIMI)FACILITY TYPE:
850
ADDRESS:1350 WAYNE WAYTELEPHONE:
(650) 577-0257
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:70CENSUS: 50DATE:
07/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Director, Dina SchmalzTIME COMPLETED:
02:00 PM
NARRATIVE
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C1= unnamed child, T1= Teacher #1, T2= Teacher #2.

On July 20, 2021 at 12:35pm Licensing Program Analyst (LPA) conducted an unannounced, case management inspection at Kindercare LLC (PS). LPA met with director, Dina “Mimi” Schmalz. The purpose of the visit was explained to director.

The case management regarded an unusual incident that was reported to CCLD by facility on 07/01/2021. Per director, on 07/01/2021 at about 1:30pm, a child enrolled in 5s classroom (C1) was left unattended and unsupervised in restroom. Director stated while students in 5s classroom was transitioning from the classroom to playground, C1 used the restroom without any teacher’s knowledge. T2 found C1 in 4s classroom unattended and reported incident to director. Director stated T1 assigned to the classroom failed to count children prior to transitioning entire class to playground. Per director, child was left unattended and unsupervised for 1-2 minutes. Director reported incident to CCLD on 07/01/2021. Plan of correction included director providing all staff renewed training on supervision protocols. T1 received personal renewed training and coaching.

Based on interviews, record review and facility self-reporting, a child was left unattended and unsupervised in facility, therefore a Type A violation has been cited under CCR, Title 22, Div. 12, Chapter. 1. Please refer to 809D for more information.

After today’s visit, an exit interview was conducted with director, Dina “Mimi” Schmalz. A copy of this report was emailed to dschmalz@kindercare.com with Appeal Rights and Procedures. Upon receipt of this report, director shall post the Notice of Site Visit and any Licensing report documenting a Type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain postings as required will result in an immediate $100 civil penalty. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC9224 to be kept in each child's file.

This report is public and can be reviewed.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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, 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: 07/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/20/2021
Section Cited

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101229(a)(1) Responsibility for Providing Care and Supervision…No child(ren) shall be left without the supervision of a teacher at any time. This requirement was not met as evidenced by:
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Based on interviews and record review, the facility self-reported a child was left unattended and unsupervised for 1-2 minutes. This poses an immediate Health, Safety and/or Personal Rights risk to children in care.
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Deficiency cleared during LPA inspection.

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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: Cindy InterianoTELEPHONE: (650) 266-8864
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: (650) 393-8293
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2021
LIC809 (FAS) - (06/04)
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