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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406690
Report Date: 03/02/2021
Date Signed: 03/02/2021 04:06:00 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:KIDZ ACADEMY, INC.FACILITY NUMBER:
434406690
ADMINISTRATOR:CAROLYN MENDOZAFACILITY TYPE:
850
ADDRESS:1224 NORTH WINCHESTER BLVDTELEPHONE:
(408) 261-9523
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:43CENSUS: 4DATE:
03/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Patricia MendozaTIME COMPLETED:
04:00 PM
NARRATIVE
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LPA Janet Tse met with director Carolyn Mendoza to conduct a case management inspection. Due to the COVID-19 pandemia, this inspection was conducted via Facetime. LPA explained to Director that this inspection was in regards to the fingerprint clearances of a staff. LPA observed four children with one teacher in Room 3.

During the tele-inspection on 02/24/2021, LPA observed teacher Brenda Johnson did not have fingerprint clearances associated to the facility. After the inspection, LPA verified with the San Jose Regional Office office support staff that there is no record of a fingerprint transfer request in file. Support staff also search for the staff's fingerprint clearances association both in the Licensing Information System and the Guardian Background Check System, and found that Brenda Johnson does not have fingerprint association to this facility.

LPA also reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearance, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

LPA discussed the requirements of AB633 to Director and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and Director understands the requirements. Upon receipt, Director 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.

Deficiency was cited and civil penalty of $500 was assessed. Notice of site visit was issued and must be posted with the type A deficiency for 30 days.

Due to COVID 19, a copy of this Licensing report with LPA's signature alone will be emailed to Director; and in lieu of Director's signature, a read receipt of the email will serve as acknowledgement of receipt of this Licensing report by Director.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2021
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
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: 03/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/03/2021
Section Cited

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Personnel Requirements. Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall:
...Request a transfer of a criminal record clearance as specified in Section 101170(f)...
This requirement was not met as evidenced by: During the tele-inspection on 02/24/2021,
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LPA observed teacher Brenda Johnson did not have fingerprint clearances associated to the facility.
This poses an immediate risk to the Health, Safety, or Personal Rights to children in care.
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Civil penalty of $500 was assessed.

Due to COVID 19, a copy of this Licensing report with LPA's signature alone will be emailed to Director; and in lieu of Director's signature, a read receipt of the email will serve as acknowledgement of receipt of this Licensing report by Director.

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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet TseTELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2021
LIC809 (FAS) - (06/04)
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