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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400340
Report Date: 05/24/2023
Date Signed: 05/24/2023 02:35:32 PM


Document Has Been Signed on 05/24/2023 02:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
434400340
ADMINISTRATOR:GINA SWANNFACILITY TYPE:
830
ADDRESS:840 BING DRIVETELEPHONE:
(408) 246-2141
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:56CENSUS: 37DATE:
05/24/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Marcella Tarin/Mandy HernandezTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analysts (LPA's) Mel Matos and Anna Morales conducted a Case Management inspection and toured the infant classrooms and infant playgrounds. LPA's observed cockroaches in the outside playground(s).

Based on our observations, a Type B citation was issued at today's inspection. A copy of the Facility Evaluation Report LIC809/809D and a copy of the appeal rights was given to Director, Marcella Tarin prior to the conclusion of today's inspection.

Notice of site visit issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Anna MoralesTELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
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 05/24/2023 02:35 PM - 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
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: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2023
Section Cited
CCR
101238(a)(1)

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Buildings and Grounds, 101238(a)(1)The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

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Director stated that they have a Pest Control conducting monthly services. Next services is scheduled for today, May 24,2023. Director will implement a plan that will address the next step to erridicate the pest problem. Director will submit the plan by the POC date.
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(1) The licensee shall take measures to keep the center free of flies, other insects, and rodents. This was not met by: LPA's observed coackroaches in the infant playground, which 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: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2