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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400337
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:42:47 PM


Document Has Been Signed on 09/13/2023 03:42 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:SANDERS, EBONYFACILITY TYPE:
850
ADDRESS:1081 FOXWORTHY AVENUETELEPHONE:
(408) 265-7380
CITY:SAN JOSESTATE: CAZIP CODE:
95118
CAPACITY:96CENSUS: 51DATE:
09/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maggie CorralTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analysts (LPAs), Janette Cruz and Jessica Bongardt, met with Maggie Corral, interim Director for an unannounced case management inspection in response to a self-reported Unusual Incident that the Facility reported to the Department.

The Unusual Incident occurred around 2:45PM on 08/25/2023 when a preschool child (C1) ran out of the classroom (Room 6) and went to the playground. Maggie states that there was one teacher (T1) supervising 10 napping preschool children in Room 6. Maggie stated that the T1 ran after C1 and left the rest of the children who were napping in the classroom unsupervised for about 5 minutes. LPA toured indoor and outdoor areas of the facility. LPA observed that Room 6 had two doors, one with direct access leading to the busy street of Foxworthy Avenue and the other back door leading to the fenced playground. LPA observed that the fenced playground had an alarmed and locked door not accessible for children to exit. Maggie stated that incident of children being left unattended by T1 could have been avoided if T1 used available communication devices (phone or walkie talkies) inside the classroom to call for help from other preschool staff to watch Room 6.

Maggie stated that all 10 children from Room 6 including C1 were unharmed. Maggie states that teacher, T1, had her employment terminated due to abandonment of children napping in Room 6. Maggie states that C1's mother was informed about the incident and C1's mother decided to remove C1 from the daycare the same day of incident. Maggie states a staff training regarding active supervision was conducted on 9/6/23 to discuss supervision requirements for children. Copies of the following documents were provided by Maggie to LPA's : child roster, LIC500Personnel Report, proof of in-service training.

Exit interview was conducted and report reviewed with Maggie Corral, Interim Director.
Deficiencies were cited during today's inspection. See 809-D. A notice of site visit and copy of today's report was given and must be posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
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 09/13/2023 03:42 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: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/14/2023
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 except as specified in sections 101216.2(e)(1) and 101230(c)(1). This requirement was not met as evidenced by:
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Licensee will submit a written Plan of Correction (POC) to LPA Cruz indicating what steps will be implemented to ensure that the preschool children are supervised at all times by POC due date. Civil penalty was assessed and LIC 421M was given to interim Director during today's visit .
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Based on observation, interviews and record reviews, nine preschool child napping were left unattended in classroom 6 for approximately 5 minutes on 8/25/23. This poses an immediate threat to health and safety of children in care.
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According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months and copy of signed acknowledgement form must be kept in each child's file. According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months and copy of signed acknowledgement form must be kept in each child's file.

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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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 09/13/2023 03:42 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: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2023
Section Cited
CCR
101170(e)(2)

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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)
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Licensee shall submit statement of understanding of regulation violated by POC due date. Civil Penalty of $100 assessed. (See LIC421BG)
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Based on observation, interview and record review, Licensee did not comply with section cited above. Licensee did not associate staff (T1's)criminal record clearance to the facility during her period of enrollment which poses a potential health, safety or personal rights risk to persons 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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023
LIC809 (FAS) - (06/04)
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