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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013415908
Report Date: 07/10/2024
Date Signed: 07/10/2024 03:48:27 PM

Document Has Been Signed on 07/10/2024 03:48 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
013415908
ADMINISTRATOR/
DIRECTOR:		MA, YVONNEFACILITY TYPE:
830
ADDRESS:32710 FALCON DRIVETELEPHONE:
(510) 324-3569
CITY:FREMONTSTATE: CAZIP CODE:
94555
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 27DATE:
07/10/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:26 PM
MET WITH:Yvonne MaTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 7/10/2024 Licensing Program Analyst (LPA) Jaleesa Jackson conducted an unannounced case management visit. LPA met with Director Yvonne Ma. Present for the inspection was 10 staff and 27 infants in care.

During record review and interviews, the facility did not report to the Department the water damage prior to construction. The facility had a large area of the wall removed after water damage was discovered. During today's visit the Director called in to report the water damage and construction. The repair work happened over the weekend but was not completed prior to the child care center's opening on Monday 7/8/2024. LPA reviewed the reporting requirements regulation with Director.

See 809-D for deficiencies cited during today's inspection.

Exit interview conducted with Yvonne Ma and appeal rights provided.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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 07/10/2024 03:48 PM - It Cannot Be Edited


Created By: Jaleesa Jackson On 07/10/2024 at 02:37 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
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 013415908

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/17/2024
Section Cited
CCR
101237(a)

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Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s).
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Director will review the reporting requirement video and submit a signed and dated statement understanding the regulation by POC date to LPA by email.
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This requirement was not met as evidenced by:
Based on interview and record review, Licensee did not notify department of the water damage and construction required to repair it which poses a potential risk to the children's health and safety.
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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:Jason Jang
LICENSING EVALUATOR NAME:Jaleesa Jackson
LICENSING EVALUATOR SIGNATURE:
DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/10/2024


LIC809 (FAS) - (06/04)
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