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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400335
Report Date: 10/25/2023
Date Signed: 10/25/2023 10:15:48 AM


Document Has Been Signed on 10/25/2023 10:15 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: 23DATE:
10/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Reyna ReyesTIME COMPLETED:
10:20 AM
NARRATIVE
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Licensing Program Analyst (LPA), Janette Cruz , met with facility assistant director, Reyna Reyes, 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 staff interviews pertinent to this case management inspection. LPA also reviewed staff and children's records on facility file. Based on the available information, a deficiency is being cited, see 809-D. Appeal rights were given.
Exit interview was conducted and reviewed with Reyna Reyes, assistant 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: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023
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 10/25/2023 10:15 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: 10/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/26/2023
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by:
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Licensee submitted documents that termination of employment was processed on 9/14/23 for staff, T2, who violated child's personal rights. T2 no longer works in the facility.
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Based on observation, interview and record review, Licensee did not comply to section cited above. Staff T2 was observed by staff T1 force feeding child C1 which posed immediate threat to health and safety of children in care.
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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: 10/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2