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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004173
Report Date: 04/07/2022
Date Signed: 04/07/2022 02:27:20 PM

Substantiated


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
03/03/2022 and conducted by Evaluator Catrina Quimbo
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220303153431
FACILITY NAME:KINDERCARE LEARNING CENTER LLC (INF)FACILITY NUMBER:
414004173
ADMINISTRATOR:DINA SCHMALZ (MIMI)FACILITY TYPE:
830
ADDRESS:1350 WAYNE WAYTELEPHONE:
(650) 577-0257
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:32CENSUS: 21DATE:
04/07/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Christy Michele BermudezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff provided formula to incorrect daycare child.
Staff provided a daycare child with scissors while in care.
INVESTIGATION FINDINGS:
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On April 6, 2022 at 1:00pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, complaint investigation to Kindercare Learning Center LLC (INF). LPA met with director, Christy Michele Bermudez. The purpose of the visit was explained to director.

Facility is a combination center with a separate preschool and infant license. Under the infant license, there are 3 classrooms (2 infant classrooms, 1 toddler classroom). Under infant license, there are 8 staff members with 21 children present.

During investigation, LPA conducted classroom observations, interviews and reviewed records and documents.

(Continue Report on Page 2...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
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 5
Control Number 05-CC-20220303153431
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 (INF)
FACILITY NUMBER: 414004173
VISIT DATE: 04/07/2022
NARRATIVE
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(Continued, Page 2...)

On 3/1/2022, facility self reported incident of staff member providing formula to incorrect day care child to CCLD. On 3/2/2022, facility submitted unusual incident report regarding staff member providing formula to incorrect day care child to CCLD. Random selection of staff interviewed stated a staff member provided formula to incorrect day care child.

On 3/15/2022, director provided LPA Kindercare employee handbook. Employee handbook states "Creating a safe...environment is the number one responsibility of every employee" (pg. 4). Random selection of staff interviewed stated a staff member in infant classroom was unaware an enrolled infant had possession of staff member's scissors. Random selection of staff interviewed stated enrolled infant maintained possession of staff member's scissors when transitioning from one classroom to another classroom.

Based on LPA's observations, interviews and record review which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, are being cited. Please refer to 9099D for more information.

After today’s visit, an exit interview was conducted with director, Christy Michele Bermudez. A copy of this report and Notice of Site Visit will be emailed to michele.bermudez@kindercare.com with Appeal Rights and Procedures. Upon receipt of this report, director shall post the Notice of Site Visit documenting a Type “B” deficiency. The Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain postings as required will result in an immediate $100 civil penalty. This report is public and can be reviewed.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 05-CC-20220303153431
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 (INF)
FACILITY NUMBER: 414004173
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/15/2022
Section Cited
CCR
101427(c)
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101427 Infant Care Food Service (c) The infant shall be fed in accordance with the individual plan.

This requirement was not met as evidenced by:
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Facility self-reported incident to CCLD. Director notified parents of infants involved. Director provided staff member with additional one on one training. Director provided additional training to all infant staff members.
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Based on observations, interviews and record review, a staff member provided formula to an incorrect day care child. This poses a potential health, safety or personal rights risk to children in care.
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Director to provide LPA proof of completed staff member training with written documentation. Document to indicate what was reviewed and what will be done in the future. Proof of written documentation will be submitted to LPA no later than 4/15/2022 by 5:00pm.
Type B
04/15/2022
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights (a)(2) The licensee shall ensure that each child is…to be accorded safe…accommodations…and equipment to meet his/her needs.

This requirement was not met as evidenced by:
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Director provided staff member with one on one training with written documentation. Director to provide additional training to all infant staff members on how to maintain overall health and safety for enrolled children with written documentation.
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Based on interviews and record review, staff member was unaware infant had possessed staff member’s scissors. This poses a potential health, safety or personal rights risk to children in care.
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Document to indicate what was reviewed and what will be done in the future. Proof of written documentation will be submitted to LPA no later than 4/15/2022 by 5:00pm.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/03/2022 and conducted by Evaluator Catrina Quimbo
PUBLIC
COMPLAINT CONTROL NUMBER: 05-CC-20220303153431

FACILITY NAME:KINDERCARE LEARNING CENTER LLC (INF)FACILITY NUMBER:
414004173
ADMINISTRATOR:DINA SCHMALZ (MIMI)FACILITY TYPE:
830
ADDRESS:1350 WAYNE WAYTELEPHONE:
(650) 577-0257
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:32CENSUS: 21DATE:
04/07/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Christy Michele BermudezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff does not meet the minimum qualifications.
Staff did not properly report incidents involving a daycare children.
INVESTIGATION FINDINGS:
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On April 6, 2022 at 1:00pm, Licensing Program Analyst (LPA) Catrina Quimbo conducted an unannounced, complaint investigation to Kindercare Learning Center LLC (INF). LPA met with director, Christy Michele Bermudez. The purpose of the visit was explained to director.

Facility is a combination center with a separate preschool and infant license. Under the infant license, there are 3 classrooms (2 infant classrooms, 1 toddler classroom). Under infant license, there are 8 staff members with 21 children present.

During investigation, LPA conducted classroom observations, interviews and reviewed records and documents. Staff working in classrooms are fully qualified and/or are working to become fully qualifed. LPA observed facility maintains children to teacher ratio throughout classrooms.

(Continue Report on Page 2...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 05-CC-20220303153431
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 (INF)
FACILITY NUMBER: 414004173
VISIT DATE: 04/07/2022
NARRATIVE
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(Continued, Page 2...)

On 3/1/2022, facility self reported incident of staff member providing formula to incorrect day care child to CCLD. On 3/2/2022, facility submitted unusual incident report regarding staff member providing formula to incorrect day care child to CCLD. Director properly reported incident to licensing and to families involved. LPA advised director to be more detailed for future incidents when reporting to licensing.

Although the above allegation may have happened or is valid, based on LPA's observations, interviews and record review which were conducted, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

After today's visit, an exit interview was conducted with director, Christy Michele Bermudez. A copy of this report and Notice of Site Visit will be emailed to michele.bermudez@kindercare.com. Upon receipt of this report, director shall post the Notice of Site Visit. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain postings as required will result in an immediate $100 civil penalty. This report is public and can be reviewed.
SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5