<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709779
Report Date: 04/22/2019
Date Signed: 04/22/2019 05:30:38 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
430709779
ADMINISTRATOR:MONICA VILLALOBOSFACILITY TYPE:
850
ADDRESS:860 N. HILLVIEW DRIVETELEPHONE:
(408) 263-0444
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:87CENSUS: 49DATE:
04/22/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Monica VillalobosTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced Annual Inspection of the Preschool. LPA met with Director Monica Villalobos and explained the purpose of the inspection.

Facility’s License, Parents’ Rights Poster, and Activity Schedules were observed to be posted. Facility's operating days and hours are Monday through Friday 6:30 AM to 6:15 PM. LPA inspected the building inside and out with Director. Facility was observed to be in compliance with teacher to children ratio requirement during the inspection. The Facility operates Infant/Toddler, Preschool Age, and School Age Programs in the same building. The Preschool Program is located in four classrooms, "Two's Classroom," "Preschool Classroom," "Pre-K Classroom," and "Kindergarten Classroom." There were no bodies of water observed.

Facility's classroom, play area, restrooms, kitchen, storage area, and office room were inspected. Director stated that facility does not possess nor store any weapons on the premises. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Furniture and equipment such as mats, cots, tables, and chairs were age appropriate and were in good condition, free of sharp, loose, or pointed parts. Restrooms for children's use was observed to be in safe, sanitary, and operating condition. Floors were clean and free from tripping hazard.

Outdoor activity space is fenced and play equipment were maintained in a safe condition and free of hazards. There were no bodies of water observed. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls. There were shaded rest areas for children. Drinking water are arranged to be readily available to children during indoor and outdoor activities.

Facility provides meals. Menu was posted. Foods and beverages were kept protected against contamination and spoilage. Kitchen and food storage area were clean, free of litter and rubbish. Trash cans for solid waste had tight-fitting covers on, and were in good repair.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2019
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 430709779
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2019
Section Cited
CCR
101220(a)
1
2
3
4
5
6
7
CHILD'S MEDICAL ASSESSMENT. Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child.

This requirement is not met as evidenced by:
Per LPA's review of files, Child 1 through
1
2
3
4
5
6
7
BY POC DUE DATE, 05/03/19, Facility will send a copy of a completed Medical Assessment for Child 1 through 3 to Licensing Office to show proof of correction.
8
9
10
11
12
13
14
3 do not have record of a written medical assessment in their file during the inspection. They have been enrolled at the school for more than 30 days. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
05/03/2019
Section Cited
CCR
101220.1(g)
1
2
3
4
5
6
7
IMMUNIZATIONS. The child’s immunizations shall be documented and maintained on file as long as the child is enrolled.
This requirement is not met as evidenced by:
Based on LPA's review of children's files, Child 1 does not have documented immunization record at the facility for review during
1
2
3
4
5
6
7
BY POC DUE DATE, 05/03/19, Director agreed to obtain a copy of Child 1's immunization record and maintain the record on file. A copy of the record will be sent to Licensing Office to show proof of correction.
8
9
10
11
12
13
14
inspection. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2019
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 430709779
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2019
Section Cited
CCR
101229.1(b)
1
2
3
4
5
6
7
SIGN IN AND OUT. The person who brings the child to, and removes the child from, the center shall sign the child in/out.
This requirement is not met as evidenced by:
Based on LPA's audit of April Sign In/Out record for the children in care, there were more than 10 children who were not signed
1
2
3
4
5
6
7
BY POC DUE DATE, 05/03/19, Director will send to Licensing Office a plan of action on how facility will ensure that parents are signing their children in and out.
8
9
10
11
12
13
14
in and/or out on certain days of the month even though they were in attendance. This poses a potential risk to the health & safety of children in care.
8
9
10
11
12
13
14
Type B
05/03/2019
Section Cited
HSC
1596.7995
1
2
3
4
5
6
7
HEALTH & SAFETY CODE. Commencing September 1, 2016, 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. [...] The day care center shall maintain documentation of the required immunizations.
1
2
3
4
5
6
7
BY POC DUE DATE, 05/03/19, Director agreed to obtain a copy of the documentations that show proof that Staff Layla Mazloom and Savannah Maduro are immunized against Measles and Pertussis. A copy of the record will be sent to Licensing to show proof of correction.
8
9
10
11
12
13
14
This requirement is not met as evidenced by: Per LPA's review of files, Staff Layla Mazloom and Savannah Maduro do not have documented evidence of immunity against Measles and Pertussis available for review during the inspection. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2019
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 430709779
VISIT DATE: 04/22/2019
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Currently, facility does not provide transportation for the Preschool Age Program. First Aid Kit was inspected. Facility has a 2019 Milpitas Fire Department Permit. LPA observed a fire sprinkler system, and smoke and carbon monoxide detectors. Fire Extinguisher was last serviced on 03/2018.

Facility files were reviewed including the Children sign in and out procedure. A sampling of Children files was selected for review. Records reviewed include Admission Agreement, Identification and Emergency Information, Medical Assessment, Consent for Emergency Medical Treatment form, Immunization, and LIC9224 form. A sampling of Staff files was selected for review. The records reviewed include: Criminal Record and Child Abuse Index Clearance, Health Screening Report with TB Clearance, immunization record, training such as the AB1207 Online Mandated Reporter Training, and Education Qualification. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one staff with current certification in Pediatric CPR and First Aid present during the inspection.

LPA reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Facility is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information, see Evaluator Manual – Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

In the areas that were evaluated, regulatory violation was observed at the time of the visit; therefore, citations were issued. Exit Interview was conducted, where this report, the citations, plan of corrections, and appeal rights were reviewed and discussed with Director Monica Villalobos.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2019
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 430709779
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2019
Section Cited
CCR
101174(d)
1
2
3
4
5
6
7
DISASTER AND MASS CASUALTY PLAN. Disaster drills shall be conducted at least every six months. The drills shall be documented.
This requirement is not met as evidenced by:
Per Director and Drill Log reviewed, the last drill was conducted in August 2018, which has
1
2
3
4
5
6
7
BY POC DUE DATE, 05/03/19, Licensee agreed to conduct a Fire and Disaster drills and document the date and time. A copy of the Drill log will be sent to Licensing Office as proof of correction.
8
9
10
11
12
13
14
been over six months. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2019
LIC809 (FAS) - (06/04)
Page: 5 of 5