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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400332
Report Date: 10/25/2024
Date Signed: 10/28/2024 08:45:15 AM

Document Has Been Signed on 10/28/2024 08:45 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KINDERCARE LEARNING CENTERFACILITY NUMBER:
434400332
ADMINISTRATOR/
DIRECTOR:		LYNDA NGUYENFACILITY TYPE:
830
ADDRESS:3320 SAN FELIPE ROADTELEPHONE:
(408) 270-0980
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 16DATE:
10/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:42 AM
MET WITH:Lynda NguyenTIME VISIT/
INSPECTION COMPLETED:
11:25 AM
NARRATIVE
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On 10/25/2024 at 8:42am, Licensing Program Analyst (LPA) Farida Raja met with Director, Lynda Nguyen and conducted an unannounced Case Management inspection in response to an unusual incident that was self reported by the facility to Licensing on 10/22/2024. The alleged incident occurred on October 22, 2024 involving one toddler child (C1).

LPA toured the infant program and conducted interviews. LPA obtained copies of pertinent records.

Based on the available evidence and interviews completed, Director was informed by parent through a written note that C1 did not react to wheat and oats in an allergy test and they can slowly introduce these foods to the child. Based on file review, LPA did not observe an updated needs and services plan completed for the child.

As a result of this inspection, one Type B deficiency. Exit interview conducted and report was reviewed with Director, Lynda Nguyen. Appeal Rights provided.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
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 10/28/2024 08:45 AM - It Cannot Be Edited


Created By: Farida Raja On 10/25/2024 at 11:00 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
, 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: 10/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited
CCR
101419.3(a)

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101419.3 Modifications to Infant Needs and Services Plan (a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.

This requirement is not met as evidenced by:
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Director to submit a plan of correction to LPA by plan of correction date of 11/08/2024.
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Based on interviews and record review, LPA observed that the needs and services plan has not been updated for child (C1). THis poses a potential risk to the health, safety or personal rights of children 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:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024


LIC809 (FAS) - (06/04)
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