434400416-10-20-2022-07-CC-MMOO-CKDUGL-20221020153430

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400416
Report Date: 10/20/2022
Date Signed: 10/20/2022 03:37:39 PM

Document Has Been Signed on 10/20/2022 03:37 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:	KINDERLAND CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434400416
ADMINISTRATOR:	SOLOMON, SHULAMIT		FACILITY TYPE:	850
ADDRESS:	10352 NORTH STELLING ROAD		TELEPHONE:	(408) 861-0160
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	75	CENSUS: 24	DATE:	10/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:16 AM
MET WITH:	Shulamit Solomon		TIME COMPLETED:	03:50 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 (LPA) Marilou Monico conducted an unannounced Required - 1 Year Inspection. LPA met with Site Director, Shulamit Solomon. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 8:00 AM to 5:30 PM. The Toddler Option Program is licensed in Room 1 and the Preschool Program is licensed in Rooms 2 thru 5. The facility serves children ages 18 months to entry into first grade. The facility has an active waiver: toddler option program to share the bathroom with the preschool program at separate times. LPA toured the facility both indoor and outdoor. LPA observed that the facility was operating in compliance with teacher to children ratio requirement. LPA observed the children in the toddler option program were using Room 2 which is licensed for preschool. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean. LPA observed a diaper changing table within arm's reach of a sink in Room 1. There are five (5) toilets and nine (9) sinks available for the children. There is a staff stall in the children's bathroom which a sick child can use if needed. Foods and beverages were kept protected against contamination and spoilage. Drinking water is available for the children indoor by pitchers and disposable cups. Trash cans for solid waste had tight-fitting covers on, and were in good repair. Fire extinguisher, working smoke and carbon monoxide detectors were observed. Continuation on next pages:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

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: KINDERLAND CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434400416
	VISIT DATE: 10/20/2022

NARRATIVE

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Site Director indicated that there are no firearms in the facility. Drinking water is readily available for the children outdoor by pitchers and disposable cups. The playgrounds are surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by canopy, trees, and umbrellas. LPA observed rubber foam as resilient material under and around the climbing structures. There were no bodies of water observed.

LPA reviewed six (6) children's files. Children records reviewed include Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report, Medical Assessment, Immunization, and TB test. LPA obtained copy of children's roster.

Four (4) staff files were reviewed. Staff records reviewed include Criminal Record Clearance, Personnel Record, Employee Rights, Statement Acknowledging Requirement to Report Child Abuse, Health Screening Report with TB Clearance, Immunizations (Measles, Pertussis, and Flu) and required Training. Based on record review, Staff #1 & #4 have expired Mandated Reporter Training. LPA reminded Site Director that the online Assembly Bill (AB)1207 Mandated Reported Training shall be renewed every two years. At least one staff member present during the inspection has current certifications in Pediatric CPR and First Aid.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

Continuation on next page:

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: KINDERLAND CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434400416
	VISIT DATE: 10/20/2022

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LPA discussed the safe sleep regulations with Site Director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA informed Site Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Site 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.

The following items must be submitted to Licensing by October 28, 2022:
1) Updated Personnel Report (LIC 500)
2) Emergency Disaster Plan (LIC 610)

As a result of this inspection, deficiencies were cited on the following page:

Exit interview conducted and report was reviewed with the Site Director, Shulamit Solomon.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/20/2022 03:37 PM - It Cannot Be Edited

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: KINDERLAND CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434400416
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/20/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, Staff #1 & #4 have expired Mandated Reporter Training for Child Care Providers. This poses a potential risk to health, safety or personal rights of children in care.
	POC Due Date: 11/21/2022
	Plan of Correction
1 2 3 4	Site Director states that she will submit proof of completion by 11/21/22.

Type B

Section Cited

CCR

101216.4(a)(2)

Preschool Program with Toddler Component

(2) The toddler program shall be conducted in areas physically separate from those used by older or younger children. Space planning and usage for the toddler component shall be governed by the provisions of Section 101438.3. Plans to alternate use of outdoor play space must be approved by the Department. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA's observation, the toddler option children were using Room 2 which is licensed for the preschool program. This poses a potential risk to the health, safety or personal rights of children in care.
	POC Due Date: 10/28/2022
	Plan of Correction
1 2 3 4	The children in the toddler option program were immediately moved from Room 2 to Room 1 during the inspection. Site Director states that she will submit a written plan by 10/28/22 to ensure that toddler option children will only be using Room 1 as indoor space.

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022

LIC809 (FAS) - (06/04)

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