Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434400345
Report Date: 06/15/2016
Date Signed: 06/15/2016 04:52:18 PM


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
04/14/2016 and conducted by Evaluator Mahvash Behbood
COMPLAINT CONTROL NUMBER: 07-CC-20160414130704
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434400345
ADMINISTRATOR:IDA GEMIGNANI-STEARNSFACILITY TYPE:
850
ADDRESS:400 SOUTH ABELTELEPHONE:
(408) 263-7212
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:120CENSUS: 86DATE:
06/15/2016
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Jannette PetrakTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Facility does not provide adequate supervision resulting in child being injured
INVESTIGATION FINDINGS:
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A visit was made by analyst Behbood to further investigate the above allegations. Met Jannette, Assistant Director. The purpose of the visit explained. Additional children's file were reviewed for incident reports. Child Supervision Records reviewed. Copies obtained.
Based on record review, the preponderance of evidence standard has been met, therefore the above allegations found to be SUBSTANTIATED. California Code of Regulations, are being cited on the attached LIC. 9099D.”

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 07-CC-20160414130704

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: 06/15/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/20/2016
Section Cited
101229(a)
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Responsibility for Providing Care and Supervision - he licensee shall provide care and supervision as necessary to meet the children's needs.
Based on the review of the incident reports in classroom #3, there are numerous bitting, falling, and scratching incidents.
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The same plan of correction being provided for the pervious citation issued today would correct this citation.
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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: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2016
LIC9099 (FAS) - (06/04)
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