Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414001398
Report Date: 06/22/2018
Date Signed: 06/22/2018 03:27:16 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/18/2018 and conducted by Evaluator Andrea Medlin
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20180618114040
FACILITY NAME:KINDERCARE LEARNING CENTER LLC (PS)FACILITY NUMBER:
414001398
ADMINISTRATOR:SCHMALZ, DINA (MIMI)FACILITY TYPE:
850
ADDRESS:1350 WAYNE WAYTELEPHONE:
(650) 577-0257
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:70CENSUS: DATE:
06/22/2018
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jasmine ThomasTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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NEGLECT/LACK OF SUPERVISION: A child (C1) was left in the classroom without any supervision.
INVESTIGATION FINDINGS:
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LPA Andrea Medlin met with staff for this complaint visit. Purpose of the visit explained. On 6/18/18, a child "C1" was left in the classroom during outside transition time. One staff was monitoring the bathroom while the other was checking children's names as they transitioned outside. The child left in the classroom did not have his name on the list and was unaccounted for. Staff did not notice they had left C1 in the classroom. Another parent/teacher had brought child to the director's office notifying she had found C1 in the classroom crying alone. Based on staff admission and facility self reported the incident, this allegation is determined to be substantiated.

The deficiency cited on the following page is in violation of the California Code of Regulations, Title 22, Division 12, Chapter 1:

This report was reviewed with director and a copy of this report must be made available for public review upon request. Due to Type A violation, this report and violation must be given to all parents and documented on the LIC 9224 and returned to each child's file. Notice of site visit posted and shall remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 05-CC-20180618114040
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: KINDERCARE LEARNING CENTER LLC (PS)
FACILITY NUMBER: 414001398
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/25/2018
Section Cited
CCR
101229(a)(1)
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101229(a)(1) Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time.
On 6/18/18, a child was left in the classroom alone unsupervised and unaccounted for until a parent/teacher found child.
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Director counseled the staff involved individually regarding supervision of children and separated the classroom into two groups.

(See below)
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$150 zero tolerance violation civil penalty assessed today for this violation.
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Director to conduct an all staff meeting with regard to care and supervision of children.

Director to provide an agenda to licensing by 6/25/18 and subsequently send proof of the staff meeting once completed.
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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: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Andrea MedlinTELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2018
LIC9099 (FAS) - (06/04)
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