<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406753
Report Date: 10/18/2022
Date Signed: 10/18/2022 11:59:57 AM


Document Has Been Signed on 10/18/2022 11:59 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:KIDANGO RUSSOFACILITY NUMBER:
434406753
ADMINISTRATOR:MICHELLE MAGANAFACILITY TYPE:
850
ADDRESS:2851 GAY AVENUETELEPHONE:
4083530780
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:22CENSUS: 0DATE:
10/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Michelle Magana 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
pLicensing Program Analyst (LPA),Stephanie Collins, conducted an unannounced case management inspection in response to a lead testing completed with exceedances levels. The positive lead finding was self reported to Community Care Licensing (CCL). LPA met with the Director Michelle Magana and explained the nature of today's inspection to her.

Prior to today's inspection the facility self reported by submitting an unusual incident report, Self-Certification LIC9275, Sampling Checklist Form LIC9276, Facility Sketch LIC 999, labeled with locations of the water outlet, and full lead report. The lead exceedance readings were found in outside drinking fountain near the play area. Preceding the LPA’s arrival the affected and identified area of concern ( play- yard fountain ) had been blocked-off mark made an inoperable source of water. Staff and children are using a different source of water. The center provides drinking water from the indoor lead-free fountain and children are encouraged to bring the own bottles of water while outside.

During today's inspection LPA Stephanie observed that the water sources were no longer operational. LPA observed the center posted notification to parent of the Assembly Bill 2370.

Type B deficiency cited, exit interview conducted, and a copy of this report was reviewed with the Director Michelle Magana . Appeal rights were reviewed and provided.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
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 2


Document Has Been Signed on 10/18/2022 11:59 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: KIDANGO RUSSO
FACILITY NUMBER: 434406753

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2022
Section Cited

1
2
3
4
5
6
7
Lead Testing Written Directive section 101700.3(b)(1), a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was not net as evidence by:

The exceedances level found (play yard- fountain). This poses potential risk to the Health Safety, or Personal Rights of Children in care.


1
2
3
4
5
6
7

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Gladys KuizonTELEPHONE: (408) 314-5102
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2