Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434400345
Report Date: 09/07/2017
Date Signed: 09/07/2017 04:33:23 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
09/01/2017 and conducted by Evaluator Shannel Reed
COMPLAINT CONTROL NUMBER: 07-CC-20170901100311
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: 49DATE:
09/07/2017
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Danielle Enos and Araceli CortezTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Director allowed day-care child to be signed out by an unauthorized adult.
INVESTIGATION FINDINGS:
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LPA'S Mel Matos and Shannel Reed conducted an unannounced complaint inspectiont to Facility. LPAS interviewed Danielle Enos and Araceli Cortez, acting center director and acting assistant director, and discussed the allegation with them. LPAS reviewed and obtained copies of sign in/ out sheets and the one child's file. Based on the available evidence, LPAS conclude that the Facility allowed an unauthorized adult to sign out a preschool child on August 31, 2017. The Facility failed to check the Indentifiaction and Emergency Information form (LIC 700) or the Facilities Enrollment Agreement to confirm which adults are authorized to sign the child out of the Facility. A staff person ultimately stopped the unauthorized adult from taking the child, but only after the staff person heard that the adult did not have an age appropriate safety seat for the child. The preponderance of evidence standard has been met and thus the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12, Chapter 1), are being cited on the attached LIC. 9099-D.
A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2017
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-20170901100311
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 434400345
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/07/2017
Section Cited
CCR
101223(a)(2)
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Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. the Facility allowed an unauthorized adult to sign out a preschool child on August 31, 2017.
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Licensee agreed to submit a written Plan of Correction to LPA Matos by Monday September 11, 2017 addressing what action(s) have been taken to ensure that the Facility is in compliance with appropriate sign in and sign out proceedures.

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The Facility failed to check the Indentifiaction and Emergency Information form (LIC 700) or the Facilities Enrollment Agreement to confirm which adults are authorized to sign the child out of the Facility.
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According to AB 633, parents must be provided with this report which contains Type A deficiencies for the next 12 months.

A copy of the signed LIC 9224 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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2017
LIC9099 (FAS) - (06/04)
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