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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400342
Report Date: 08/19/2024
Date Signed: 08/20/2024 09:20:42 AM

Document Has Been Signed on 08/20/2024 09:20 AM - 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434400342
ADMINISTRATOR/
DIRECTOR:		MARCELLA TARINFACILITY TYPE:
850
ADDRESS:840 BING DRIVETELEPHONE:
(408) 246-2141
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 21DATE:
08/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Sara PopovichTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
NARRATIVE
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Licensing Program Analyst(LPA) Anna Morales conducted a Case Management Inspection and was greeted by Director Sara Popovich. LPA toured the Preschool Classrooms, #4(DP),5(Preschool) and #6(Pre-K empty classroom). LPA observed that the facility was observed to be in compliance with teacher to child ratio requirement during visit.

The purpose for this inspection is issue TYPE B citations for incomplete files for three staff (S1-S3) that were observed during today's inspection.

LPA discussed the citations and Plan of Correction with Director Sara Popovich. Appeal Rights were givens.

Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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 3
Document Has Been Signed on 08/20/2024 09:20 AM - It Cannot Be Edited


Created By: Anna Morales On 08/19/2024 at 09:23 AM
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: 434400342

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2024
Section Cited
CCR
101216(g)(1)

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(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
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Director showed proof that S1 has a completed Health Screening and Tb test date 7/17/24, however S2 and S3 don't. Director stated that she will submit coples of Health Screening/TB for S2 and S3 by POC date
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Based on observation, interview, and record review, the licensee did not comply with the section cited above for S1, S2, S3, which poses a potential health, safety or personal rights risk to persons in care.
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Type B
08/30/2024
Section Cited
HSC1596.7995(a)(1)

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1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

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Director showed proof that S1 has proof of Immunizations,however S2 and S3 don't. Director stated that she will submit coples of immunizations and influenza(or decline statement for S2 and S3 by POC date
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This requirement is not met as evidenced by:
Based on observation, interview and record review, the licensee did not comply with the section above for S1, S2 and S3, 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:Gladys Kuizon
LICENSING EVALUATOR NAME:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/20/2024 09:20 AM - It Cannot Be Edited


Created By: Anna Morales On 08/19/2024 at 10:46 AM
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: 434400342

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2024
Section Cited
CCR
101217(a)

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(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
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Director showed LPA during today's inspection, 8/19/24, that S2 has completed the required personnel documentation. This POC is now cleared.
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Based on observation, interview and record review, the licensee did not comply with the section cited above for S2, 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:Gladys Kuizon
LICENSING EVALUATOR NAME:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 08/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/19/2024


LIC809 (FAS) - (06/04)
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