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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004173
Report Date: 07/09/2019
Date Signed: 07/09/2019 05:15:02 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 (INF)FACILITY NUMBER:
414004173
ADMINISTRATOR:DINA SCHMALZ (MIMI)FACILITY TYPE:
830
ADDRESS:1350 WAYNE WAYTELEPHONE:
(650) 577-0257
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:32CENSUS: 19DATE:
07/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Dina SchmalzTIME COMPLETED:
05:30 PM
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Licensing Program Analyst Glenn Schnell conducted a case management inspection in response to receiving an unusual incident report on from approximately 5/29/19. Director Schmalz reported that the parents of an infant informed her that they had taken their child to the doctor to be evaluated for mouth pain. The child was diagnosed with a fractured jaw, and the doctor indicated that it could have been the result from the child or another child forcefully pulling a toy or object out of their mouth. Director Schmalz followed up with the parents and gave them a detailed tour of the infant room. As a result of a separate evaluation of the toys and equipment accessible to the infants in the infant room, Director Schmalz removed some of the toys as a precaution. There was no determination as to where or how the infant was injured. The infant was observed in care today to be active with no signs of discomfort or not wanting to play with or around other children and staff. LPA Schnell conducted an evaluation of the physical plant and toys. All equipment and toys were determined to be age appropriate and supervision of the environment was adequate.
LPA Schnell determined that this incident was reported timely and handled in an appropriate manner by Director Schmalz.

No deficiencies cited. A Notice of Site Visit was posted.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Glenn A SchnellTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
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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