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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408010
Report Date: 07/17/2023
Date Signed: 07/17/2023 03:27:23 PM


Document Has Been Signed on 07/17/2023 03:27 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434408010
ADMINISTRATOR:POPOVICH, SARAHFACILITY TYPE:
850
ADDRESS:1515 S. DE ANZA BLVDTELEPHONE:
(408) 861-9510
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:116CENSUS: 85DATE:
07/17/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:37 PM
MET WITH:Sarah PopovichTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marilou Monico made a Case Management Inspection in response to an unusual incident that was self-reported by the facility to Licensing on July 11, 2023. LPA met with Site Director, Sarah Popovich, and explained the nature of today's inspection. LPA toured the facility, interviewed staff, reviewed files, and obtained documents.

Based on available evidence and interviews, it was determined that on July 11, 2023, the children in Discovery Preschool 2 Room (DP2) were transitioning from the classroom to the playground when staff realized that C-1 was not in the group. DP2 Room is located adjacent to the playground. C-1 was observed by staff standing between the glass door and window of DP2 Room. C-1 was brought back to his group by S-1. Site Director was notified by staff (S-2). Site Director immediately contacted C-1's parent and reported the incident. Site Director conducted retraining of DP2 Room teachers including S-1 on supervision and all classroom transitions are being supervised by management for two weeks to ensure that center protocols are being followed. Site Director submitted written Plan of Correction during the inspection.

Exit interview was conducted and report was reviewed with Site Director, Sarah Popovich.

As a result of this inspection, deficiency was cited on the following page:

A NOTICE OF SITE VISIT WAS GIVEN 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: 07/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023
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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Document Has Been Signed on 07/17/2023 03:27 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 434408010

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/18/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision - (a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Site Director conducted immediate retraining of DP2 Room teachers including S-1 on supervision and all classroom transitions are being supervised by management for two weeks to ensure that center protocols are being followed. Site Director submitted written Plan of Correction during the inspection.
Deficiency corrected.
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This requirement was not met as evidenced by: A child (C-1) was observed by staff unattended in DP2 Room while his group was in the playground. DP2 Room is located adjacent to the playground. This poses an immediate risk to the health, safety, and personal rights of children in care.

An immediate civil penalty of $500 was assessed.
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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 07/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/17/2023
LIC809 (FAS) - (06/04)
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