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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408010
Report Date: 09/30/2024
Date Signed: 09/30/2024 11:01:50 AM


Document Has Been Signed on 09/30/2024 11:01 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:
434408010
ADMINISTRATOR:CINDY CALDERONFACILITY TYPE:
850
ADDRESS:1515 S. DE ANZA BLVDTELEPHONE:
(408) 861-9510
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:92CENSUS: 35DATE:
09/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Nicole VanderietTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Marilou Monico conducted a Case Management inspection in response to an Unusual Incident Report that was received by Licensing on September 27, 2024 involving a daycare child (C1). LPA met with Infant/Preschool Assistant Director, Nicole Vanderiet. Based on interview with Assistant Director, the incident occurred at another Kindercare location.

LPA reviewed and obtained copy of Assistant Director's file.

There were no deficiencies cited.

A Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2024
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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