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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403523
Report Date: 12/09/2021
Date Signed: 12/09/2021 03:58:48 PM

Document Has Been Signed on 12/09/2021 03:58 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
434403523
ADMINISTRATOR:AMANDA HERNANDEZFACILITY TYPE:
830
ADDRESS:1155 EAST ARQUES AVENUETELEPHONE:
(408) 245-3276
CITY:SUNNYVALESTATE: CAZIP CODE:
94085
CAPACITY: 73TOTAL ENROLLED CHILDREN: 40CENSUS: 40DATE:
12/09/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Amanda "Mandy" HernandezTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mel Matos conducted an unannounced case management inspection and met with Amanda "Mandy" Hernandez. Purpose of today's inspection: self reported unusual incident that occurred at the Facility on October 29, 2021.

Mandy states that an infant child was left unattended outside one of the infant classrooms on October 29, 2021. Mandy states that there were eight infant children with two staff at the time of the incident. Mandy states that staff became aware of the incident when a parent noticed that their child was not part of the classroom group that passed through the lobby area of the Facility en route to the playground for a Halloween parade. Mandy states that the parent proceeded to go check the infant classroom and noted that the child was standing directly outside the classroom. Mandy states that the child was not upset or crying as a result of the incident and appeared to be waiting for someone to come back to get the child. Mandy states that the child was brought back to the group and she proceeded to talk to the staff about the incident and remind them about supervision requirements. Mandy states that she also conducted Child Supervision Record (CSR)Training with all infant staff on November 22, 2021. Copies of training materials were provided to LPA during today's inspection.

LPA notes that the infant classrooms are enclosed and any access to exiting the Facility is through the front lobby which has front desk staff, including assistant directors. LPA did not observe any health/safety hazards in the hallway area adjacent to the infant classroom

It is concluded that an infant child was left unattended outside of one of the infant classrooms on October 29, 2021 as a result of lack of supervision. Based on the available evidence, this presented a potential risk to the health/safety of the child in care. A "Type B" deficiency is thus noted on the attached page (LIC 809-D).

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
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 12/09/2021 03:58 PM - It Cannot Be Edited


Created By: Melvin S Matos On 12/09/2021 at 03:33 PM
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: 434403523

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2021
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: 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 agrees to submit a written Plan of Correction by Thursday December 16, 2021 indicating what steps the Facility has implemented to ensure that children are supervised at all times.
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This requirement was not met as evidenced by: An infant child was left unattended outside of one of the infant classrooms on October 29, 2021
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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:Diana Stephenson
LICENSING EVALUATOR NAME:Melvin S Matos
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2021


LIC809 (FAS) - (06/04)
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