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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434400340
Report Date: 12/21/2022
Date Signed: 12/22/2022 09:04:17 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2022 and conducted by Evaluator Anna Morales
COMPLAINT CONTROL NUMBER: 07-CC-20221201080618
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434400340
ADMINISTRATOR:GINA SWANNFACILITY TYPE:
830
ADDRESS:840 BING DRIVETELEPHONE:
(408) 246-2141
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:56CENSUS: 26DATE:
12/21/2022
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Lauren Ferrell TIME COMPLETED:
03:55 PM
ALLEGATION(S):
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1. Infant was provided care and supervision in the facility without proper admission to the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Morales met with Assistant Director Lauren Ferrell for a follow up complaint investigation. Purpose of today investigation: deliver investigation findings.

The investigation of the complaint allegation listed above was conducted by LPA Morales.
Based on interviews, record reviews, observations, and evidence gathered during the investigation process, the Department concludes that a Infant was provided care and supervision in the facility without proper admission to the facility
It is thus concluded that the above allegation is found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met. A "Type B" deficiency is being cited on the attached LIC 9099-D. A Notice of Site Visit was provided to Assistant Director and must remain posted for 30 days.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
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 2
Control Number 07-CC-20221201080618
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 434400340
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/18/2023
Section Cited
CCR
101419.2(a)
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101419.2 Infant Needs and Services Plan
a) Prior to the infant's first day at the center, the infant care center director or assistant director shall complete a needs and services plan for the
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Assistant Director acknowledged requirement and stated proof will be submitted to LPA by 1/18/2023
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the infant. This was evident by; Facility failed to complete a needs and services plan for C1, as required for children who are under 24 months old. This poses a potential risk to the 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: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2