<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400332
Report Date: 09/13/2023
Date Signed: 09/14/2023 04:07:38 PM

Document Has Been Signed on 09/14/2023 04:07 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434400332
ADMINISTRATOR:LYNDA NGUYENFACILITY TYPE:
830
ADDRESS:3320 SAN FELIPE ROADTELEPHONE:
(408) 270-0980
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 14DATE:
09/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Lynda NguyenTIME COMPLETED:
01:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Farida Raja and Licensing Program Manager (LPM), Gladys Kuizon, conducted an unannounced case management inspection. LPA and LPM met with director, Lynda Nguyen.
LPM and LPA were on site to investigate a complaint investigation for another facility number.

During children's record review, LPA and LPM observed eczema medication and consent form for child, C1, but facility does not have instructions from child's authorized representatives to administer the prescription ointment.

Type B deficiency was cited today on the attached LIC 809D page. Appeal rights were printed and provided to Licensee. Exit interview was conducted with Director, Lynda Nguyen.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/14/2023 04:07 PM - It Cannot Be Edited


Created By: Farida Raja On 09/13/2023 at 12:02 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: 434400332

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2023
Section Cited
CCR
101226(3)(B)

1
2
3
4
5
6
7
101226 Health Related Services- (3)(B)For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.
1
2
3
4
5
6
7
Director will submit proof of correction to LPA by Plan of Correction date of 09/20/2023.
8
9
10
11
12
13
14
LPA and LPM observed eczema medication and consent form for child, C1, but facility does not have instructions from child's authorized representatives to administer the prescription ointment. This poses a potential risk Health, Safety Personal Rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2