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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400337
Report Date: 03/27/2024
Date Signed: 03/27/2024 04:45:59 PM


Document Has Been Signed on 03/27/2024 04:45 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:
434400337
ADMINISTRATOR:MARGARITA CORRALFACILITY TYPE:
850
ADDRESS:1081 FOXWORTHY AVENUETELEPHONE:
(408) 265-7380
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:96CENSUS: 61DATE:
03/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Reyna ReyesTIME COMPLETED:
04:54 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Cortney Nelson and Farida Raja, met with Assistant Site Director, Reyna Reyes, and explained purpose of todays visit. Upon arrival, LPAs were admitted into the facility by the assistant director.

During review of children's files, LPAs observed that three (3) children are missing physician's report (LIC701). LPAs reminded that physicians report shall be submitted prior to enrollment date or within thirty (30) days of enrollment. All children missing physician reports have been enrolled into the program beyond the thirty (30) day period.

LPAs observed that Acknowledgement of Receipt of Licensing Report (LIC9224) was only in one child's file, regarding Type A citations from visit conducted on 3/14/2024. LPAs advised that a copy of the licensing report (LIC9099) shall be provided to parents/authorized representatives of currently enrolled children and to children enrolling into the program for the next 12 months. Signed LIC9224 shall serve as signed documentation that the parents received a copy of the report.

During today's visit, LPAs additionally observed classroom #3 was over ratio as twenty four preschool-age children were observed with one teacher and one qualified aide. LPAs advised that teachers shall have twelve semester units including the core courses of child development, curriculum, and child, family, community.

LPAs informed facility representative (Reyna Reyes) that this report dated (3/27/2024) documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


Document Has Been Signed on 03/27/2024 04:45 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: 434400337

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/26/2024
Section Cited
CCR
101220(a)

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101220 Child's Medical Assessments (a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement was not met as evidenced by:
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LPAs provided list of children who need physicians report completed to the Assistant Director and requested that the completed LIC701 is submitted to the Department by 4/26/2024.
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During review of children's files, LPAs observed that three out of twenty one files did not contain a physicians report (LIC701) prior to enrollment or within thirty days following enrollment, which poses a potential risk to the health, safety, and personal rights of children in care.
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Type B
04/03/2024
Section Cited
HSC1596.8595(c)(4)

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1596.8595 Posting licensing report by child care facility or home; duration of posting; civil penalty for failure to comply; reports to be provided to parents or guardian of each child receiving services (c)(4) The licensee shall keep verification of receipt in each child's file.

This requirement was not met as evidenced by:
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The facility shall obtain signed copies of LIC9224 for all parent currently enrolled into the preschool component and place copies in the children's files for review and verification.
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During review of classroom #4 files, LPAs observed twenty out of twenty one files did not contain signed verification (LIC9224) of report from 3/14/2024 regarding Type A citations, which poses a potential risk to the health, safety, and personal rights of children in care.
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Scanned copies of signed reports (LIC9224) shall be submitted for all preschool parents to the Department by 4/3/2024.
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: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4


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: 434400337
VISIT DATE: 03/27/2024
NARRATIVE
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LPAs informed facility representative (Reyna Reyes) that this report dated (3/27/2024) documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risks to the health, safety, or personal rights of children in care.

Also, LPAs informed the licensee to provide a copy of this licensing report dated (3/27/2024) that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

As a result of today's inspection, deficiencies were cited, see LIC809-D.

Exit interview conducted and the report was reviewed with the Assistant Site Director, Reyna Reyes.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 03/27/2024 04:45 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: 434400337

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/28/2024
Section Cited
CCR
101216.3(a)

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101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance..

This requirement was not met as evidenced by:
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The facility shall submit POC by 3/28/2024 for program administrator to complete additional units and be fully qualified as she does not have the units required to step in for fully qualified staff.
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The Licensee did not ensure that staff are not with more than 12 preschoolers at one time as classroom #3 was observed with twenty four children, staffed with one fully qualified teacher and one qualified aide, which poses an immediate risk to the health, safety, and personal rights of children in care.
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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: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4