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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400334
Report Date: 05/10/2023
Date Signed: 05/15/2023 10:44:27 PM

Document Has Been Signed on 05/15/2023 10:44 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434400334
ADMINISTRATOR:LYNDA NGUYENFACILITY TYPE:
850
ADDRESS:3320 SAN FELIPE ROADTELEPHONE:
(408) 270-0980
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 81TOTAL ENROLLED CHILDREN: 81CENSUS: 53DATE:
05/10/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Lynda NguyenTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Farida Raja and Anna Morales conducted an unannounced case management inspection to discuss water lead testing which resulted in one action level exceedance at the facility. LPAs met with Director, Lynda Nguyen, and explained the purpose for the inspection. LPAs toured the facility and requested to identify Sample Site ‘E’ with reported Action Level Exceedance (value of 5.5 parts per billion or greater). The lead testing completed by Forensic Analytical on 10/25/2022 indicated site "E" had an Action Level Exceedance (ALE) value of 39 ppb. LPAs observed that the sink with the ALE is located next to the diaper changing station in the Discovery Preschool Classroom. Director stated that this sink is not used for food preparation or for children's drinking water purposes.

The following documents were submitted to analysts during today's inspection:
1) Self-Certification (LIC9275) completed by Certified External Water Sampler
2) Sampling Checklist Form (LIC9276)
3) Facility Sketch (LIC999) labeled with locations of water outlets that were tested.
4) Proof of work order to replace fixture

Director stated that they have placed a work order to get the fixture replaced for the particular sink with the ALE and they will have the water re-sampled and tested. Director stated that the children use their individual water bottles and pitcher of water for drinking purposes. LPAs observed that children have their own individually labeled water bottles and do not have access to sink faucet with the ALE.

Type B deficiency was cited, exit interview conducted, and a copy of this report was given and reviewed with the Director, Lynda Nguyen. Appeal rights were reviewed and provided. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2023
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 05/15/2023 10:44 PM - It Cannot Be Edited


Created By: Farida Raja On 05/10/2023 at 01:43 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 434400334

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2023
Section Cited

101700.3

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Lead Testing Written Directives (b)(1) a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.

This requirement was not met as evidenced by: After water lead testing was completed, the facility had one sink faucet (E) located in one preschool classroom attached to the diaper changing area with an Action Level Exceedance of 39ppb, which poses a potential risk to the health, safety, and personal rights of children in care.

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Director, Lynda Nguyen has placed a work order to replace the fixture and re-test the water for lead. Director provided proof of work order during today's visit.

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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023


LIC809 (FAS) - (06/04)
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