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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400335
Report Date: 09/14/2023
Date Signed: 09/14/2023 11:22:22 AM


Document Has Been Signed on 09/14/2023 11:22 AM - 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434400335
ADMINISTRATOR:SANDERS,EBONYFACILITY TYPE:
830
ADDRESS:1081 FOXWORTHY AVENUETELEPHONE:
(408) 265-7380
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:48CENSUS: 30DATE:
09/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Maggie Corral TIME COMPLETED:
11:50 AM
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 Analysts (LPAs), Janette Cruz and Jessica Bongardt, met with facility interim director Maggie Corral, for an unannounced case management inspection in response to a self-reported Unusual Incident that was reported to the Department on 09/08/23. LPA observed child to staff ratio were in compliance during today's inspection.

On 09/08/2023, assistant Director Reyna Reyes reported to the Department that on 09/07/23, a teacher (T1) witnessed an infant (C1) being force fed via feeding bottle by another teacher (T2).

LPA conducted additional staff interviews pertinent to this case management inspection. LPA also reviewed staff and children's records on facility file. Based on the available information, Further investigation is required and shall be continued on a later date.

Deficiencies were cited during this inspection, appeal rights given. Exit interview was conducted and reviewed with Maggie Corral, Director.

Notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
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 09/14/2023 11:22 AM - 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 434400335

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/28/2023
Section Cited
CCR
101220(a)(d)(1)(2)

1
2
3
4
5
6
7
101220 Child's Medical Assessments
(a) 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 medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.
(d) If a medical assessment is not available for a child and cannot be obtained within 30 days of admission:
(1) A medical appointment date shall be obtained from the authorized representative upon the child's admission.
(2) A TB test shall be obtained on the child within 30 days of admission.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit a completed LIC701Physician's report for C1 by POC due date. Licensee will also submit statement of understanding of regulation 101220 Child's Medical Assessments
8
9
10
11
12
13
14
Based on observation, interview and record review, Licensee did not comply to section cited above. Child C1 did not have a completed LIC701Physician's Report upon inspection which poses potential threat to health and safety of children in care.
8
9
10
11
12
13
14
Type B
09/28/2023
Section Cited
HSC1596.8662(b)(1)

1
2
3
4
5
6
7
§1596.8662 Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and 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:
1
2
3
4
5
6
7
Licensee will submit proof of completed Mandated Reporter Training Certification for staff who require renewal of the training. Licensee will also submit statement of understanding of regulation.
8
9
10
11
12
13
14
Based on observation, interview and record review, Licensee did not comply to section cited above. LPA observed staff T1 and T2 did not have current mandated reporter training certificate on file which poses potential threat to 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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2