434406690-8-20-2019-07-CC-TDON-BF8UUH-20190820155333

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434406690
Report Date: 08/20/2019
Date Signed: 08/20/2019 03:53:42 PM

COMPREHENSIVE INSPECTION

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:	KIDZ ACADEMY, INC.		FACILITY NUMBER:	434406690
ADMINISTRATOR:	CAROLYN MENDOZA		FACILITY TYPE:	850
ADDRESS:	1224 NORTH WINCHESTER BLVD		TELEPHONE:	(408) 261-9523
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95050
CAPACITY:	43	CENSUS: 17	DATE:	08/20/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Carolyn Mendoza		TIME COMPLETED:	12:10 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 Analysts (LPAs) Tuoc Doan and Pietro Hernandez conducted an unannounced Annual inspection of the Preschool. LPAs met with Director Carolyn Mendoza and informed her the purpose of the visit. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, and LIC613A Personal Rights were observed to be posted. The Preschool's operating days and hours are Monday through Friday 06:30 AM to 06:00 PM. Facility was observed to be in compliance with teacher to child ratio requirement during inspection. Children were under the direct visual supervision of staff. LPAs inspected the physical plant. The Facility operates Infant/Toddler Program and Preschool Program in the same building. The Preschool is located in classroom 1B, 2, and 3. Director informed LPAs during the inspection that the facility would like to increase the capacity of their infant license by taking classroom 1B from the Preschool Program and add it to their Infant Program. LPAs reviewed with Director the procedures that facility needs to follow for Licensing to process the change. LPAs inspected the building inside and out. The Classrooms, one children restroom, one staff restroom, maintenance/utility storage room, Kitchen, and office were inspected. There were no bodies of water observed. Director stated that facility does not have weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Restroom for children to use were observed to be in operating conditions. Floors were clean. Outdoor activity space for the Preschool Program is fenced and is physically separated from the Infant/Toddler playground. Play equipment were maintained in a safe condition and free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. Drinking water is arranged to be readily available for children in care. Shade is provided by trees, building overhang, etc.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019

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: KIDZ ACADEMY, INC.	FACILITY NUMBER: 434406690
	VISIT DATE: 08/20/2019

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPAs 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.

Director stated facility is not providing transportation to children.

In the areas that were evaluated, regulatory violations were observed at the time of the visit. Exit interview was conducted, where this report, the violations, plan of corrections, and appeal rights were discussed 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 Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019

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: KIDZ ACADEMY, INC.	FACILITY NUMBER: 434406690
	VISIT DATE: 08/20/2019

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Facility provides two meals (Breakfast and Lunch), and two snacks (Morning and Afternoon). Kitchen and food storage area were clean, free of litter, and rubbish. Foods and beverages were kept protected against contamination and spoilage. Menu was posted. Trash cans for solid waste have tight fitting lid.

First Aid Kit was inspected. Facility has a Fire Safety and Hazardous Materials Permit expiring on 06/30/2020. LPAss observed fully charged fire extinguishers, and smoke and carbon monoxide detectors.

LPAs reviewed sign in and out record and procedure with Director. A sampling of children and staff files was taken for review during today's inspection. Children records reviewed include Admission Agreement, Identification and Emergency Contact Information, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment, and Immunization.

Staff records reviewed include Criminal Record and Child Abuse Index Clearance, Education Qualification, Health Screening Report with TB Clearance, Immunization (Measles and Pertussis) record and required Training. LPA reminded Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPAs 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 per day 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.

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. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

LPAs also reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.ca.gov] to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019

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: KIDZ ACADEMY, INC.	FACILITY NUMBER: 434406690
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/20/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/23/2019 Section Cited CCR 101238(g)	1 2 3 4 5 6 7	BUILDINGS AND GROUNDS. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. This requirement is not met as evidenced by: During the inspection LPAs' observed bottles of cleaning compounds like	1 2 3 4 5 6 7	During inspection Director removed the bottles of cleaning compounds and stored them temporarily on higher shelvings that are out of reach of children. BY POC DUE DATE, 08/23/19, Director will submit to Licensing Office a plan of action
	8 9 10 11 12 13 14	dish soap and disinfectant solutions stored in cabinets under the sink of the Kitchen & near ground level in the maintenance room at the hallway. Although there are doors to close off the areas, Preschool children can potentially open the door and wander into the areas, thus posing a potential risk to their health & safety.	8 9 10 11 12 13 14	detailing how Director will keep all the cleaning solutions and other items that could pose a danger to children if readily available, inaccessible to the children.
Type B 09/20/2019 Section Cited HSC 1596.8662(b)(1)	1 2 3 4 5 6 7	MANDATED REPORTER TRAINING. [...] a person who, on January 1, 2018, is a licensed child care provider [...] shall complete the mandated reporter training provided [...] and shall complete renewal mandated reporter training every two years [...]. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	BY POC DUE DATE, 09/20/2019, Director agreed to ensure that all staff completes the online AB1207 Mandated Reporter Training. A copy of Director's Certificate of Completion will be sent to Licensing Office to show proof of correction.
	8 9 10 11 12 13 14	Per LPAs' review of the files during inspection, none of the staff at the facility has the training certificate. Director stated that she was unaware of the training requirement. This poses a potential risk to children's health and safety of children in care.	8 9 10 11 12 13 14

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 Knight	TELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc Doan	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019

LIC809 (FAS) - (06/04)

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