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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414001398
Report Date: 03/06/2024
Date Signed: 03/06/2024 12:16:09 PM


Document Has Been Signed on 03/06/2024 12:16 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:KINDERCARE LEARNING CENTER LLC (PS)FACILITY NUMBER:
414001398
ADMINISTRATOR:CHRISTY BERMUDEZFACILITY TYPE:
850
ADDRESS:1350 WAYNE WAYTELEPHONE:
(650) 577-0257
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:70CENSUS: 61DATE:
03/06/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Michele BermudezTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kassandra Medrano conducted an inspection met with center director, Christy "Michele" Bermudez. The purpose of the inspection was explained to the director. LPA Medrano toured the facility and inspected for health and safety hazards. Facility is operating within capacity requirements and ratios at time of LPA's inspection. During today's inspection, 7 staff files were reviewed and 5/7 staff were missing documentation of mandated reporter training, as well as documentation of immunization's.

California Code of Regulations, Title 22 deficiencies are being cited on the following page(s):

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Michele
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 400-9920
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024
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 03/06/2024 12:16 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
SAN BRUNO CC RO, 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: 03/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2024
Section Cited
HSC
1596.8662(b)(1)

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Administration of Child Day Care Licensing
(b) (1) ... licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training p... shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
This requirement was not met as evidenced by:
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Director to send documentation of the completion for the 5 reviewed, as well as a written statement for the review of the remainder of staff files.
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Based on review of 7 files it was found that 5 staff files were missing mandated reporter trainings. This poses a potential health and safety risk to children in care.
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Type B
04/08/2024
Section Cited
HSC1596.7995(a)(1)

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General Provisions and Definitions
(a) (1)...a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement was not met as evidenced by:
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Director to send documentation of the completion for the 5 reviewed, as well as a written statement for the review of the remainder of staff files.
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Based on review of 7 files it was found that 5 staff files were missing documentation of immunizations. This poses a potential health and safety risk to children in care.
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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: Ali ZebilaTELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 400-9920
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2