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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410601
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:17:36 PM

Document Has Been Signed on 07/20/2023 02:17 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:LIFE CONNECTIONS LEARNING CENTER - KINDERCAREFACILITY NUMBER:
434410601
ADMINISTRATOR:TIFFANY BRUNNINGSFACILITY TYPE:
850
ADDRESS:3571 NORTH FIRST STREETTELEPHONE:
(408) 424-3500
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY: 252TOTAL ENROLLED CHILDREN: 185CENSUS: 116DATE:
07/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Tiffany BrunningsTIME COMPLETED:
02:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mel Matos met with Tiffany Brunnings, Executive Director, for an unannounced case management investigation. Purpose of today's investigation: investigate an incident that the Facility self reported to the Department on June 28, 2023.

The Unusual Incident occurred on June 27, 2023 at 4:15 PM. Tiffany states that the preschool children were preparing to transition back into the Facility when several parents arrived to pick up their respective children at the playground. Tiffany states that individual classrooms were lining up near the entrance doors to transition back inside the Facility.

Tiffany states that one of the parents propped open the one of the doors which leads from inside the Facility to the playground to allow one parent to walk inside and another to walk onto the playground. Tiffany states that one preschool child followed the parent that had propped open the door back inside the Facility. Tiffany states that there were two parents inside at the time of the incident and states that one parent immediately brought the child back outside to the playground.

Tiffany states that coaching and retraining on safety and supervision protocols was provided to staff and parents were also reminded to not hold any exit doors open to ensure that children don't follow them inside the Facility. Tiffany states that she spoke with the child's parents about the incident and states that they were understanding and not upset about the incident. Tiffany states that the child is doing fine and still enrolled at the Facility.

Based on the available evidence, it is concluded that there was a lapse in supervision when a preschool child followed a parent from the playground back into the Facility. The child was immediately brought back to the playground by another parent inside the Facility. 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).

Exit interview conducted and report & appeal rights was reviewed with the Executive Director, Tiffany Brunnings.

A notice of site visit was given to Licensee and must remain posted for 30 days.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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 07/20/2023 02:17 PM - It Cannot Be Edited


Created By: Melvin S Matos On 07/20/2023 at 12:51 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: LIFE CONNECTIONS LEARNING CENTER - KINDERCARE
FACILITY NUMBER: 434410601

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2023
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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Executive Director provided LPA with safety and supervision protocols for staff regarding supervision of children during today's investigation.
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This requirement was not met as evidenced by: one preschool child followed a parent that had propped open the door leading to the playground back inside the Facility on June 27, 2023. This presented a potential risk to the health/safety of the child in care.
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Deficiency is thus cleared of today's date.

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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: 07/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2023


LIC809 (FAS) - (06/04)
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