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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400339
Report Date: 09/10/2019
Date Signed: 09/10/2019 12:39:35 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434400339
ADMINISTRATOR:BRIEANY BENDERFACILITY TYPE:
850
ADDRESS:2065 WEST EL CAMINO REALTELEPHONE:
(650) 967-4430
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94040
CAPACITY:72CENSUS: 40DATE:
09/10/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Brieany BenderTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced inspection of the Preschool to investigate the following incident that involves Child 1:

Facility reported to Community Care Licensing Office that on 08/30/19 the parent of Child 2 informed Director that the parent was concern about the way a staff handled a child on the play ground.

Interviews were conducted with Director and Staff. Children were observed. The play ground was inspected. Records were reviewed and copies were obtained.

Exit Interview was conducted, where this report was reviewed with Director.

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) 334-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019
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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