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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406691
Report Date: 08/20/2019
Date Signed: 08/20/2019 04:01:19 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:
434406691
ADMINISTRATOR:CAROLYN MENDOZAFACILITY TYPE:
830
ADDRESS:1224 NORTH WINCHESTER BLVDTELEPHONE:
(408) 261-9523
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:16CENSUS: 8DATE:
08/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Carolyn MendozaTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Tuoc Doan and Pietro Hernandez conducted an unannounced Annual inspection of the Infant Program. LPAs met with Director Carolyn Mendoza and explained the purpose of the inspection. Facility operating days and hours are Monday through Friday 6:30 AM to 6:00 PM. Facility’s License, Parents’ Rights Poster, Child Seat Belt Law,and Children's Personal Rights form were observed to be posted.

Facility was observed to be in compliance with teacher to infant ratio requirement during inspection. Infants 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 Infant/Toddler Program is located in classroom 1A. 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.

There were no bodies of water observed. Director stated that facility does not possess nor store any weapons on the premises. Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to infants were stored inaccessible. Storage containers for solid waste had tight fitting covers and were in good repair. Furniture and equipment such as cribs, mats, and changing table were in sanitary and safe condition, free of sharp, loose, or pointed parts. Infant changing table was located within arm’s reach of a sink. There were no baby walkers observed on the premises during the inspection.

Outdoor activity space for the Infant Program is fenced and is physically separated from the Preschool Outdoor activity space. 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 canopy, trees, etc.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (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: 434406691
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited
CCR
101419.3(a)
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MODIFICATIONS TO INFANT NEEDS AND SERVICES PLAN. The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.
This requirement is not met as evidenced by:
Based on LPAs' review of the files for the
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BY POC DUE DATE, 08/30/19, Facility will obtain an updated Needs and Services Plan for the 7 children identified. A copy of the plan will be sent to Licensing Office to show proof of correction.
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children, 7 Infants do not have updated needs and services plans. This poses a potential risk to the health and safety of children in care.
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Type B
08/30/2019
Section Cited
CCR
101229.1(b)
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SIGN IN AND OUT. The person who brings the child to, and removes the child from, the center shall sign the child in/out.
This requirement is not met as evidenced by:
Based on LPAs' audit of August Sign In/Out record for the children in care, Child 1 was not signed in and/or out on at least 10 occasions
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BY POC DUE DATE, 08/30/19, Director will send to Licensing Office a plan of action on how facility will ensure that children are being signed in and out by the authorized representative.
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even though Child 1 was in attendance. This poses a potential risk to the health & 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: 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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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: 434406691
VISIT DATE: 08/20/2019
NARRATIVE
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LPAs reviewed with Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. Licensee is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: www.ccld.ca.gov] to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, 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. LPAs provided a copy of the “Lead Poisoning Facts Information Flyer” to the facility.

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 KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (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)
Page: 3 of 5
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: 434406691
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited
CCR
101220(a)
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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, Child 1 does not
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BY POC DUE DATE, 08/30/19, Facility will send a copy of a completed Medical Assessment for Child 1 to Licensing Office to show proof of correction.
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have record of a written medical assessment on file during the inspection. Child 1 has been attending the program 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: 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)
Page: 5 of 5
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: 434406691
VISIT DATE: 08/20/2019
NARRATIVE
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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. LPAs observed that bottles and containers of food brought into the facility by the infant's authorized representative were individually labeled with the infant's name and current date.

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

Sign and out procedures and logs, and a sampling of Infant files was selected for review. Records reviewed includes Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Needs and Services Plan, and Immunization. Safe sleep information for infants was reviewed and provided to Director.

A sampling of Staff files was selected for review. 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. LPAs reminded Director that the AB1207 Mandated Reporter 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 during LPAs' inspection.

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.

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 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.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (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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