430710584-10-21-2022-07-CC-JCRZ-CKEUWR-20221021155711

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430710584
Report Date: 10/21/2022
Date Signed: 10/21/2022 03:57:17 PM

Document Has Been Signed on 10/21/2022 03:57 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

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: 17	DATE:	10/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Cheyenne Bohn		TIME COMPLETED:	02:00 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 (LPAs) Janette Cruz and Melvin Matos conducted an unannounced required 1-year inspection and met with Cheyenne Bohn, Director. LPAs observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610) Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. Days and hours of operations are Monday through Friday 6:00 AM to 6:00 PM. Rooms 1 & 2 are being utilized for the infant program. LPAs reviewed five children's and seven staff files (1 director, 6 teachers) during today's inspection. Each child's file reviewed contains the required forms, including Needs & Services Plans and Individual Infant Sleeping Plan. All staff files reviewed contain the required forms, including transcripts/verification of experience/immunization records, & Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Last fire/disaster drill was completed on September 22, 2022. Staff have current CPR and First Aid certifications on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities. LPAs observed that the teacher/child ratio was in compliance during today's inspection. LPAs observed 17 children with 5 teachers in Rooms 1 & 2 during today's inspection. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times and never left unattended.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: KINDERWOOD CHILD DEVELOPMENT CENTER, INC	FACILITY NUMBER: 430710584
	VISIT DATE: 10/21/2022

NARRATIVE

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LPAs observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. The Facility has adequate ventilation, including central air conditioning/heating. Director understands that the Facility must be kept free of flies and other insects & rodents. LPAs observed that all furniture and equipment is in good condition and safe for the children. Napping equipment is appropriate. LPAs observed a fully charged 3A40BC fire extinguisher. Director states that there are no weapons in the facility.

LPAs observed drinking water is readily available for the children in the facility and in the outdoor playground area via water fountains and water pitchers. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. The Facility has functioning carbon monoxide detectors in the Facility.

LPAs observed the food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. The Facility provides morning/afternoon snacks and lunches for the children. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Director states that there are no poisons in the Facility. LPAs observed a complete First Aid kit in the Facility. Director states that the Facility administers medications at this time. Director understands that smoking is not allowed on the Facility premises.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: KINDERWOOD CHILD DEVELOPMENT CENTER, INC	FACILITY NUMBER: 430710584
	VISIT DATE: 10/21/2022

NARRATIVE

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The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient materials in the playground area. Shade is provided by trees and canopies. LPA did not observe any bodies of water. Director states that the Facility does not provide transportation.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with the Director, Cheyenne Bohn . No deficiencies issued during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette Cruz	TELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022

LIC809 (FAS) - (06/04)

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