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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073401314
Report Date: 05/18/2022
Date Signed: 05/18/2022 11:26:18 AM

Document Has Been Signed on 05/18/2022 11:26 AM - 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
073401314
ADMINISTRATOR:ZIMMERMAN, PAULAFACILITY TYPE:
830
ADDRESS:150 EAST LELAND ROADTELEPHONE:
(925) 432-8800
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 36TOTAL ENROLLED CHILDREN: 32CENSUS: DATE:
05/18/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Paula ZimmermanTIME COMPLETED:
11:27 AM
NARRATIVE
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Licensing Program Analyst (LPA) Michelle Sutton conducted an unannounced case management inspection. During the course of a complaint investigation it was discovered that Kindercare Learning Center did not report to the Department of Child getting hurt during care that received medical treatment.

The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with director Paula Zimmerman.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Michelle Sutton
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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 05/18/2022 11:26 AM - It Cannot Be Edited


Created By: Michelle Sutton On 05/18/2022 at 10:30 AM
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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KINDERCARE LEARNING CENTER
FACILITY NUMBER: 073401314

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/25/2022
Section Cited
CCR
101212(d)(1)(B)

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101212 Reporting Requirements (d) [..] during the operation [..]events specified[..]written report[..]B) Any injury to any child that requires medical treatment. This requirement is not met as evidenced by:
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Director will submit a written plan on how to report an Incident Injury Report to CCLD. Director and assistant director will watch video on CCLD website for Reporting Requirements.
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Based on observation, interview and record reviews the facility did not report incident to the Department. This is a potiential risk to Health and Safety or Personal Rights risk to
persons in care.
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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Michelle Sutton
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022


LIC809 (FAS) - (06/04)
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