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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400280
Report Date: 11/01/2019
Date Signed: 11/01/2019 04:04:05 PM

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:KIDSVILLE PRESCHOOL & DAY CARE CENTERFACILITY NUMBER:
434400280
ADMINISTRATOR:SANDRA FAROTTOFACILITY TYPE:
850
ADDRESS:1247 BENTON STREETTELEPHONE:
(408) 296-7442
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:28CENSUS: 17DATE:
11/01/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Sandra FarottoTIME COMPLETED:
04:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced Annual inspection of the Preschool and its Toddler Component. LPA met with Director Sandra Farotto and informed her the purpose of the visit. Facility's License, Notification of Parents’ Right Poster, Children's Personal Rights, and Child Car Seat Law were observed to be posted. Operating days and hours are Monday-Friday 07:00 AM to 06:00 PM.

Facility currently holds two active waivers granted to commingle the toddlers and preschool children in the early morning and late afternoon and during nap time.

LPA inspected the building inside and out. The Toddler Component is located at the front of the property and the Preschool room is at the back. The Preschool and Toddler rooms, restrooms, Office, Storage area, and Kitchen were inspected. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children to use were observed to be in operating conditions. Floors were clean. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Facility provides Lunch and two snacks. Food storage area was inspected. Menu was posted. Trash can for solid waste had tight fitting covers on.

Outdoor activity space was enclosed by fence. LPA observed play equipment were maintained in a good condition, free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed. Director.stated that facility does not have weapons on the premises. Drinking water was arranged to be readily available to children. Shade is provided by trees and building overhang. First Aid kit was inspected. LPA observed that facility has Smoke and Carbon Monoxide Detectors, and fire alarm pull station. Fire Extinguishers were last serviced on 09/2019. Facility's fire/disaster drill log recorded that the last drill was conducted on 09/26/19.

LPA reviewed facility's roster, and sign in/out procedure and record.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
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 3
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: KIDSVILLE PRESCHOOL & DAY CARE CENTER
FACILITY NUMBER: 434400280
VISIT DATE: 11/01/2019
NARRATIVE
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A sampling of children and staff files was selected for review. Children records reviewed includes Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization. Staff records reviewed include Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA' inspection.

LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

Facility's Incidental Medical Services (IMS) policy was discussed with Director. Director stated that currently the facility does not have children in care who requires administration of medication. 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.

LPA also reviewed with Director the violations that would result in an immediate $500 civil penalty assessment. Facility is encouraged to visit the Department’s website at www.cdss.ca.gov
[Shortcut: ccld.ca.gov] to access resources for Providers, Regulations etc.
Beginning January 1, 2019 AB2370 requires licensed homes and centers to share information on the risks and effects of lead exposure with enrolling and re-enrolling families.

In the areas that were evaluated, regulatory violations were observed at the time of the inspection. Exit interview was conducted where this report, the violations, plan of corrections, and appeal rights were reviewed with Director.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: KIDSVILLE PRESCHOOL & DAY CARE CENTER
FACILITY NUMBER: 434400280
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2019
Section Cited

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INFANT NEEDS AND SERVICES PLAN. Prior to the infant's first day at the center, the [...] director shall complete a needs and services plan for the infant [...] The needs and services plan shall be in writing [...].
This requirement is not met as evidenced by:
LPA did not see a needs and services plan for
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Child 1, who is under 24 months old. Licensee failed to complete a needs and services plan for Child 1, as required for children who are under 24 months old. This poses a potential risk to the health and safety of children in care.
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Type B
11/08/2019
Section Cited

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CHILD'S MEDICAL ASSESSMENT. Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child.
This requirement is not met as evidenced by:
Per LPA's review of files, Licensee failed to
obtain a written medical assessment of Child 2
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who has been enrolled for more than 30 days. This poses a potential risk to the health and safety 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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2019
LIC809 (FAS) - (06/04)
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