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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 430709779
Report Date: 02/23/2022
Date Signed: 02/23/2022 10:47:23 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/18/2022 and conducted by Evaluator Manel Estoesta
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20220118085438
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
430709779
ADMINISTRATOR:EVELYN CARRILLOFACILITY TYPE:
850
ADDRESS:860 N. HILLVIEW DRIVETELEPHONE:
(408) 263-0444
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:87CENSUS: 61DATE:
02/23/2022
UNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Director Tania TrejoTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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1. Personal Rights - Daycare child fell and sustained multiple injuries.
2. Physical Plant - Facility playground pavement is in disrepair resulting in injuries.
INVESTIGATION FINDINGS:
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On Wednesday, February 23, 2022 at 9:03 am, Licensing Program Analyst (LPA) Manel Estoesta conducted an unannounced subsequent complaint investigation. LPA met with the Director Tania Trejo and explained the purpose of the visit. Present on this visit were 9 staff and 61 preshcool children. Facility operates from Monday to Friday 7:30 AM to 5:30 PM.

The findings for the above allegations were delivered during the visit.

During investigation, the department completed a physical plant inspection, reviewed facility records and documentation, and conducted interviews.

SEE 9099 C.
Substantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 52-CC-20220118085438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 430709779
VISIT DATE: 02/23/2022
NARRATIVE
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Continuation....

Allegation 1. Personal Rights - Daycare child fell and sustained multiple injuries.

Reporting Party (RP) alleged that C1 sustained injuries while in care. Facility’s Incident Report documentation showed that C1’s latest incident dated 1/12/2022. LPA reviewed C1’s Doctor’s Visit Summary dated 01/14/2022 showed a Medical Assessment of a Closed Head Injury and Nose Abrasion. Facility Staff interview confirmed that C1 tripped on the facility’s play yard uneven pavement while running, fell face first onto the concrete and received forehead “bumped” and, nose and mouth abrasion.

Based on the LPA observation, facility record review and staff interviews, the licensee is in violation of Title 22, Division 12 Chapter 1 Article 06. Continuing Requirements Section 101223 Personal Rights


(a) The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.....

Allegation 2. Physical Plant - Facility playground pavement is in disrepair resulting in injuries.

Reporting Party (RP) alleged that the facility’s playground is in disrepair resulting to C1’s injuries. On 01/21/2022 LPA Estoesta visit, LPA observed an uneven pavement on a walkway located in the facility’s playground. Facility Staff interview confirmed that C1 tripped on the facility’s playground uneven pavement while running, fell face first onto the concrete and received forehead “bumped” and, nose and mouth abrasion on 01/12/2022. LPA reviewed C1’s Doctor’s Visit Summary dated 01/14/2022 showed a Medical Assessment of a Closed Head Injury and Nose Abrasion. LPA reviewed the Kinder Care Maintenance Work Order # 195681258 dated 01/17/2022 “Uneven pavement or cement,” showed that a child fell causing a “big bump” on forehead that took him to “ER.”

Based on the LPA observation, facility record review and staff interviews, the licensee is in violation of;


Title 22, Division 12 Chapter 1 Article 07. Physical Environment Section 101238.2 Outdoor Activity Space (d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.
(1) In a safe condition for the activities planned.....

SEE 9099 C.
SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 52-CC-20220118085438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 430709779
VISIT DATE: 02/23/2022
NARRATIVE
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Continuation.....

The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED.

LPA Estoesta informed the Director that this report dated 02/23/2022 documents with Type A citations which shall be posted for 30 consecutive days as there are immediate risks to the health, safety, or personal rights of children in care.

Also, LPA Estoesta informed the Director to provide a copy of this licensing report dated 02/23/2022 that documents of any Type A citations to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director Tania Trejo

SUPERVISOR'S NAME: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 52-CC-20220118085438
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 430709779
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/23/2022
Section Cited
CCR
101223(a)(2)
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Title 22, Division 12 Chapter 1 Article 06. Continuing Requirements Section 101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.......
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The Director will conduct a staff meeting and will incorporate Identifying Hazards in the Facility staff meeting. Faclity's next staff meeting is on 03/16/2022. The Director will submit to LPA a written documentation of the Staff Meeting on or before Proof of Correction Date 3/23/2022.
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The licensee failed to maintain the playground pavement that resulted on C1's accident and injuries on 01/12/2022 and it was an immediate risk to the health, safety, and or personal rights of children in care.
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The Director stated that she will incorporate Identifying Hazards in the facility on their regular meeting.
Type A
02/23/2022
Section Cited
CCR
101238.2(d)(2)(1)
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Title 22, Division 12 Chapter 1 Article 07. Physical Environment Section 101238.2 Outdoor Activity Space (d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes.........
(1) In a safe condition for the activities planned.....
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The Director requested a Maintenance Work Order # 195681258 dated 01/17/2022 and had a work completion date on 01/26/2022. LPA Estoesta inspected the playground pavement had been repaired and took pictures on this visit.
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The licensee failed to maintain the playground pavement that resulted on C1's accident and injuries on 01/12/2022 and it was an immediate risk to the health, safety, and or personal rights of children in care.
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The Director will provide a Work Order Completion Dcoumentation. As w recommendation, the Director will incorporate Identifying Hazards in the facility on their regular meeting.
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: Jason JangTELEPHONE: (510) 725-7009
LICENSING EVALUATOR NAME: Manel EstoestaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4