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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408833
Report Date: 05/25/2023
Date Signed: 05/25/2023 12:37:49 PM


Document Has Been Signed on 05/25/2023 12:37 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:CHILD KINGDOM PRE-SCHOOL/DAYCAREFACILITY NUMBER:
434408833
ADMINISTRATOR:REY, YAMILETTEFACILITY TYPE:
850
ADDRESS:4160 SENTER ROADTELEPHONE:
(408) 365-1236
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:73CENSUS: 13DATE:
05/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Yamilette ReyTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Janette Cruz met with Yamilette Rey, Director/Licensee, for an unannounced Required- 1 Year inspection. LPA toured the indoor and outdoor areas of the facility during today's inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedule. Days and hours of operations are Monday through Friday 7:30 AM to 5:00 PM.

LPA reviewed children's files and staff files (director, one teacher) during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700) and all required licensing forms. All staff files reviewed contain the required transcripts/verification of experience/immunization records, and Health Screening Report. LPA reviewed current certificates of completion of the Mandated Reporter Training for Child Care Workers and current CPR and First Aid certifications for staff on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during outdoor activities. Sign in and sign out sheets are in compliance.



LPA observed that the teacher/child ratio was in compliance during today's inspection. Present during the inspection were 13 preschool children and two staff. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the sick area by the Director's office.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
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: CHILD KINGDOM PRE-SCHOOL/DAYCARE
FACILITY NUMBER: 434408833
VISIT DATE: 05/25/2023
NARRATIVE
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 LPA observed that all furniture and equipment are in good condition and safe for the children. Director understands that the facility must be kept free of insects & rodents. Drinking water is readily available for the children in the facility and in the outdoor playground area via water jugs and dispensers. Staff and children's bathrooms are clean, sanitary, and in working order. Director states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors indoors.

The food preparation and storage areas are clean, free of litter & rubbish, free of rodents and other vermin. There is also a hot and cold running water, refrigerator and microwave on the premises. The facility provides lunch and snacks to the children in care. Menu was posted. The kitchen used to prepare snacks was observed to be clean and sanitary. The Facility has trash cans with tight fitting lids for solid waste in the classroom. Cleaning supplies are inaccessible to the children and stored in high cabinets LPA observed a complete First Aid kit, including touch less thermometer, in the Facility.

LPA observed that the outdoor equipment is age appropriate and in good condition. Shade rest areas are provided by trees. There is sufficient resilient materials (woodchips) on the outdoor playground area. LPA did not observe any bodies of water. Director states that the Facility does not provide transportation.

Director 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.

This facility is currently not providing Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
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: CHILD KINGDOM PRE-SCHOOL/DAYCARE
FACILITY NUMBER: 434408833
VISIT DATE: 05/25/2023
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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

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/inspection-process


LPA provided Licensee with website resources on managing food allergies at school and handling medical emergencies related to food allergies.

CDC Managing Food Allergies at School
https://www.cdc.gov/healthyschools/foodallergies/index.htm

American Academy of Pediatrics Healthy Children Medical Emergencies
https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx

Exit interview conducted and report was reviewed with Director, Yamilette Rey. Deficiencies were cited and appeal rights given to Licensee during today's inspection.

A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 05/25/2023 12:37 PM - 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: CHILD KINGDOM PRE-SCHOOL/DAYCARE
FACILITY NUMBER: 434408833

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed broken fence panels that need to be replaced and wobbly wood structures surrounding the train play area within the outdoor playground space. LPA also observed cobwebs on multiple play structures of the play yard which pose a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2023
Plan of Correction
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Licensee will submit plan of action to fix the broken fence and wood structures surrounding the train play area and submit to LPA proof of repairs. Licensee will also submit photos that multiple outdoor play structures and play yard have been cleaned free from cobwebs.
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above. Licensee stated that facility's drinking water has not yet been tested for lead contamination at this time. which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2023
Plan of Correction
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Licensee will submit a plan of action to have the facility's drinking water tested for lead contamination by POC due date. Licensee has available bottled water for children and employees for drinking.
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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 4 of 5


Document Has Been Signed on 05/25/2023 12:37 PM - 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131


FACILITY NAME: CHILD KINGDOM PRE-SCHOOL/DAYCARE
FACILITY NUMBER: 434408833

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.841

Current roster of children provided care in facility required
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parents or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon requesgt.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the licensee did not comply with the section cited above, Licensee did not have a current child care roster upon inspection which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/01/2023
Plan of Correction
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Licensee will submit LPA Cruz a completed child care roster by POC due date. Licensee will also submit a written plan of action to maintain the current roster of the facility as per licensing requirements.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 5 of 5