Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434400332
Report Date: 08/04/2016
Date Signed 08/04/2016 12:29:38 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/03/2016 and conducted by Evaluator Elizabeth Berumen
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20160503082605
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:20CENSUS: 15DATE:
08/04/2016
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lynda Nguyen TIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is out of ratio
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elizabeth Berumen met with Director, Lynda Nguyen for the purpose of delivering findings on above stated allegation. LPA toured the infant classrooms and observed that facility is operating in ratio and capacity.

On May 10, 2016 LPA observed 22 children present in the infant program. The center is licensed for 20.

Based on LPA observations and interviews which were conducted and record review the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, section 101161(a)), is being cited on the attached LIC. 9099D.”
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2


Control Number 07-CC-20160503082605

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 08/04/2016
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2016
Section Cited
101161(a)
1
2
3
4
5
6
7
101161(a) Limitations on Capacity and Ambulatory Status. The licensee shall not exceed the conditions, limitations and capacity specified in the license.
The facility was over capacity on May 10,2016. License is to serve 20 children and there were 22 children present.
1
2
3
4
5
6
7
Lynda states that currently there are 19 full time children enrolled and 1 part time child enrolled.

A written plan of correction will be submitted along with names of children enrolled in the infant program.
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
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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Elizabeth BerumenTELEPHONE: (408) 318-1326
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2016
LIC9099 (FAS) - (06/04)
Page: 2 of 2