430710584-7-21-2021-07-CC-MSEA-C56MSA-20210722095136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 430710584
Report Date: 07/21/2021
Date Signed: 07/21/2021 10:51:29 AM

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
07/12/2021 and conducted by Evaluator Araceli Almaraz

COMPLAINT CONTROL NUMBER: 07-CC-20210712131454

FACILITY NAME:	KINDERWOOD CHILD DEVELOPMENT CENTER, INC		FACILITY NUMBER:	430710584
ADMINISTRATOR:	ULRICH, ELISE		FACILITY TYPE:	830
ADDRESS:	5560 ENTRADA CEDROS		TELEPHONE:	(408) 363-1366
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	30	CENSUS: 14	DATE:	07/21/2021
		UNANNOUNCED	TIME BEGAN:	07:45 AM
MET WITH:	Director Bohn, Cheyenne		TIME COMPLETED:	10:46 AM

ALLEGATION(S):

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Facility uses unsafe sleeping practices for infants in care.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Alamraz, Celi an conducted unanncounced complaint investigation. LPA met with Director Bohn, Cheyenne. This agency has investigated the complaint alleging Facility uses unsafe practices for infants in care. Upon arrival unannounced on 07/13/2021 and 07/21/2021, LPA did not observe unsafe sleep practices for infants . “Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

There were no deficiencies cited. A copy of this report was given to licensee.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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