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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400342
Report Date: 11/04/2024
Date Signed: 11/05/2024 08:40:21 AM

Document Has Been Signed on 11/05/2024 08:40 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:		SARAH POPOVICHFACILITY TYPE:
850
ADDRESS:840 BING DRIVETELEPHONE:
(408) 246-2141
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 20DATE:
11/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Melody Eslamain MaherTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
NARRATIVE
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Licensing Program Analysts (LPA's) Anna Morales and Kate Huang conducted an Case Management visit in response to an Unusual incident that was self reported by the facility to Licensing on 10/30/24. LPA's met with Director Melody Eslamain Maher. LPA's toured the facility, interviewed staff, reviewed files, and obtained documents.

Based on available evidence and interviews, it was determined that on 10/29/24, S1 and S2 were in the process of transitioning the children from the Discovery Preschool and Preschool(Classroom #4/5) from the playground back to their classrooms(#4/5). During transition, child(C1) was left without supervision in the middle of the hallway (close to classroom 4/5), and a Parent (P1) observed the child(C1) standing without supervision, and returned the child (C1)back to the classroom. According to the Child Supervision Record (CSR) there were fifteen(15) Preschool students and two staff present.

As a result of this inspection, A Type A citation was issued at today's visit, and a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents/guardians of currently and newly enrolled children for the next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files. The citation warrants an immediate civil penalty of $500.00 and is hereby assessed, See LIC421IM.

An exit interview was conducted, and Plan of Corrections were reviewed with the Director Melody Eslamain Maher.

A notice of site visit has been issued and must remain posted for 30 days. Appeal Rights Given.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2024
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 11/05/2024 08:40 AM - It Cannot Be Edited


Created By: Anna Morales On 11/04/2024 at 09:37 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: 11/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision(a)(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Director stated that she has conducted a re-training on supervision, Child Supervision Record re-trainng/name to face transitions with staff on 10/29/24. Director stated that Administratror staff are supervising the Staff during the transition process. Director provided a copy of this training to LPA's during this visit. This Deficiency is now cleared.
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this requirement was not met as evidenced by: A child was left unattended inside the Hallway on October 29, 2024.This is a zero tolerance violation. This poses an immediate risk to the health, safety, and personal rights to children in care.
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This is a zero-tolerance violation, an immediate civil penalty of $500.00 was assessed during the inspection. Upon receipt, Director shall post and provide copies of this licensing report, have LIC 9224 signed and kept on file, to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. According to AB 633, parents must be provided with this report which contains this Type A deficiency for the next 12 months & copy of the signed acknowledgment 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:Gladys Kuizon
LICENSING EVALUATOR NAME:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2024


LIC809 (FAS) - (06/04)
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