Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434400345
Report Date: 02/05/2016
Date Signed: 02/05/2016 10:51:52 AM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/11/2015 and conducted by Evaluator Milagros Aguas
COMPLAINT CONTROL NUMBER: 07-CC-20151211092503
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434400345
ADMINISTRATOR:IDA GEMIGNANI-STEARNSFACILITY TYPE:
850
ADDRESS:400 SOUTH ABELTELEPHONE:
(408) 263-7212
CITY:MILPITASSTATE: ZIP CODE:
95035
CAPACITY:120CENSUS: DATE:
02/05/2016
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Noreen KinohiTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Child was hit by another child resulting in injury
Facility lacks adequate play equipment
INVESTIGATION FINDINGS:
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LPA Meela Aguas met with Site Director, Noreen Kinohi to deliver finding of the allegation. During the course of investigation LPA learned child sustained bruise as a result of child being hit by another child when they were after one toy. LPA observed the playground did not have adequateplay equipment. Based on LPA's observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations,Title 22, Division 12 are being cited on the attached LIC. 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Milagros AguasTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3


Control Number 07-CC-20151211092503

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 434400345
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2016
Section Cited
101223(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

LPA learned a 3 year old child sustained bruise when he was hit from a toy he wanted when he pulled and let go the toy from another child.
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Site Director will send plan of correction to ensure children are safe and to avoid incident of this nature to happen.
Type B
02/05/2016
Section Cited
101239(m)(1)
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Fixtures, Furniture, Equipment & Supplies -
The licensee shall provide a variety of age-appropriate equipment, toys and materials in good condition and in sufficient quantity to allow children present to fully participate in planned activities.

LPA observed center does not have sufficient toys for the children in the playground.
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Suite Director had purchased more toys for the children to play in the playground. Deficiency has been corrected.
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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: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Milagros AguasTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2016
LIC9099 (FAS) - (06/04)
Page: 3 of 3