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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400416
Report Date: 03/14/2024
Date Signed: 03/14/2024 10:27:46 AM


Document Has Been Signed on 03/14/2024 10:27 AM - 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 CENTERFACILITY NUMBER:
434400416
ADMINISTRATOR:SOLOMON, SHULAMITFACILITY TYPE:
850
ADDRESS:10352 NORTH STELLING ROADTELEPHONE:
(408) 861-0160
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:75CENSUS: 34DATE:
03/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Shulamit SolomonTIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Marilou Monico met with Site Director, Shulamit Solomon, for an unannounced Plan of Correction inspection. The facility was cited on March 6, 2024 under Teacher-Child Ratio. LPA toured the facility and reviewed a staff file. LPA observed a teacher supervising 13 preschool children in Room 4.

As a result of this inspection, Type A deficiency was cited on the following page:

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

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2024
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 2


Document Has Been Signed on 03/14/2024 10:27 AM - 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: 03/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/15/2024
Section Cited
CCR
101216.3(a)

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Teacher-Child Ratio - There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance.
This requirement was not met as evidenced by: A teacher was alone supervising 13 children in Room 4. This poses an immediate risk to the health, safety, and personal rights to children in care.
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By POC due date: 03/15/24, Site Director will submit a written plan to ensure that the teacher-child ratio is maintained at all times.

This case will be referred to Licensing Management for review.
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Because the facility repeated a violation within 12 months, an immediate civil penalty of $250 was assessed. A civil penalty of $100 per day continues until the violation is corrected.


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Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2