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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004173
Report Date: 09/27/2022
Date Signed: 09/27/2022 12:57:22 PM


Document Has Been Signed on 09/27/2022 12:57 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
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:KINDERCARE LEARNING CENTER LLC (INF)FACILITY NUMBER:
414004173
ADMINISTRATOR:CHRISTY BERMUDEZFACILITY TYPE:
830
ADDRESS:1350 WAYNE WAYTELEPHONE:
(650) 577-0257
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:32CENSUS: 26DATE:
09/27/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Christy Michele BermudezTIME COMPLETED:
01:15 PM
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On September 27, 2022 at approximately 11:45am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced visit to Kindercare Learning Center (INF) in regards to an unusual incident that was self reported to department. LPA met with director, Christy Michele Bermudez, and explained the purpose of the visit.

Facility is a combination center with a preschool and infant license. Under infant license, present during LPA's visit included 26 children (under 24 months) and 7 staff members. Facility is operating within capacity requirements and ratios at time of LPA's visit.

Director self reported an incident to department on September 20, 2022 that occurred at facility on September 15, 2022. LPA spoke with director regarding incident.

The facility took action to conduct an internal investigation September 16, 2022 through September 21, 2022. Director took appropriate steps via multiple staff interviews and staff meetings.

No deficiencies were cited today under CCR, Title 22, Div. 12.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with director, Christy Michele Bermudez.
SUPERVISOR'S NAME: Cindy InterianoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina QuimboTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
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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