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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400332
Report Date: 02/26/2020
Date Signed: 02/26/2020 10:19:23 AM

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:
434400332
ADMINISTRATOR:LYNDA NGUYENFACILITY TYPE:
830
ADDRESS:3320 SAN FELIPE ROADTELEPHONE:
(408) 270-0980
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:20CENSUS: 12DATE:
02/26/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lynda NguyenTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analysts (LPA) Oscar Huang met with Director, Lynda Nguyen for an unannounced case management inspection. LPA reviewed child C#1 records and observed that C#1's Infant Needs and Services Plan was updated quarterly, but the changes of participating in toddler room tryout/nap was not in written as needed, nor signed by the parent/authorized representative, only verbally communicated with the parent/authorized representative.

A Type "B" deficiency being cited on the attached LIC 809-D.

Deficiency, Plan of Correction, and Appeal Right were also discussed with Director. Appeal Right provided to Director. Exit interview conducted with Director.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED NEAR THE ENTRANCE, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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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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: 434400332
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2020
Section Cited

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Modifications to Infant Needs and Services Plan: The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy. This requirement was not met as evidenced by LPA observed facility failed to
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provide updates as needed of child C#1 to parent, nor been signed by the parent, but only verbally communicated with parent. This poses a potential risk to the health and safety to the children in care.
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Director to include this topic in their next staff meeting to make sure all staff are aware of the requirements. Director to send CCL the meeting minutes, and signatures of all participants/staff.

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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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Yangcheng HuangTELEPHONE: 408-334-8321
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2020
LIC809 (FAS) - (06/04)
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