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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406751
Report Date: 12/22/2022
Date Signed: 12/22/2022 01:50:30 PM

Document Has Been Signed on 12/22/2022 01:50 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KIDANGO ARBUCKLEFACILITY NUMBER:
434406751
ADMINISTRATOR:LINDSAY MASUDAFACILITY TYPE:
850
ADDRESS:1910 CINDERELLA LANETELEPHONE:
4089058985
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 26DATE:
12/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:TIME COMPLETED:
01:41 PM
NARRATIVE
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Licensing Program Analyst (LPA), Stephanie Collins, conducted an unannounced annual inspection of the Preschool. LPA met with Director Lindsay, Masuda and informed her the purpose of the visit.

LPA arrived at the facility at 09:01 AM Notification of Parents’ Right Poster, Children's Personal Rights, Child Car Seat Laws, Child Care License, LIC 610 Emergency Disaster Form (1and 2), LIC 308 Designation of Responsibilities, and menu were observed to be posted. Facility’s operating days and hours are Monday-Friday 07:30 AM to 05:30 PM.

During visit, LPA observed a ratio of (26 children) to (5 staff). All staff present on site are associated to the facility.

Facility representative Lindsay Masuda 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.

LPA inspected the building inside and out with Director (Lindsay Masuda) . The Preschool is located on a functioning school site (Clyde Arbuckle Elementary School), in a stand along building in classrooms 77 and 75. The Preschool classroom (s), restroom (s) for children to use and office area, storage area, food storage areas were inspected. 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. There are separate staff rest room, and a designated sick area where sick children can utilize if isolation is required.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KIDANGO ARBUCKLE
FACILITY NUMBER: 434406751
VISIT DATE: 12/22/2022
NARRATIVE
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Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Facility provides two meals (Breakfast and Lunch). Meals are prepared and packaged by the facility's "Nutritional Department," which is off site, and then delivered to the facility. LPA observed that food storage areas were clean, free of litter, rubbish, and rodents/vermin. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on.

(The Preschool holds a waiver to use the Elementary School's Kindergarten play yard)), which is enclosed by fence. Activity schedule was posted. LPA observed play equipment were maintained in a good condition, free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed. Director stated that facility does not have weapons on the premises. Drinking water is arranged to be readily available to children. Shade is provided by trees, building overhang, etc. First Aid kit was inspected. Smoke and carbon monoxide detectors were observed along with fully charged fire extinguishers in each room.

Log recorded that the last fire/disaster drill was conducted on 11/14/2022. LPA reviewed facility's sign in/out procedure and record. LPA reviewed a random selection of ten children’s files. All files were observed to be complete.

LPA reviewed staff files. All files were observed to be complete.

This facility provides Incidental Medical Services – currently the facility does not have any children in care who requires IMS. 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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KIDANGO ARBUCKLE
FACILITY NUMBER: 434406751
VISIT DATE: 12/22/2022
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LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] 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



LPA reviewed with Director Lindsay Masuda violations that would result in an immediate $500 civil penalty assessment. Director is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.ca.gov] to access resources for Providers, Regulations etc.

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.

In the areas that were evaluated, no regulatory violations were observed at the time of the inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee facility representative Lindsay Masuda.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC809 (FAS) - (06/04)
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