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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410624
Report Date: 10/29/2019
Date Signed: 10/29/2019 04:36:53 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:KIDS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434410624
ADMINISTRATOR:SOLOMON, SHANIFACILITY TYPE:
830
ADDRESS:649 EAST HOMESTEADTELEPHONE:
(408) 732-5611
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:12CENSUS: 7DATE:
10/29/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Shani SolomonTIME COMPLETED:
02:00 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
Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced Annual inspection of the Infant Program. LPA met with Director Shani Solomon and explained the purpose of the inspection. Facility's operating days and hours are Monday through Friday 7:30 AM to 6:00 PM. Facility’s License, Parents’ Rights Poster, and Personal Rights were observed to be posted.

LPA inspected the physical plant. The Infant Program is located in Room #4. 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. Director stated that the facility does not provide meal snack service to the infant program. Bottles and containers of food brought into the facility by the infant's authorized representative needs to be individually labeled with the infant's name. Foods and beverages were kept protected against contamination and spoilage.Storage containers for solid waste had tight fitting covers and were in good repair. Furniture and equipment such as cribs and changing table were in sanitary and safe condition, free of sharp, loose, or pointed parts. There were no baby walkers observed on the premises during the inspection.

Infant outdoor activity space is enclosed with fencing. 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 infants in care. First Aid Kit was inspected. LPA observed smoke and carbon monoxide detectors, and fire alarm system. Fire Extinguisher was last serviced on 10/2019. Log shows that the last fire/disaster drill was conducted on 05/10/19.

LPA reviewed facility's sign in/out procedure and record. A A sampling of Infant files was selected for review. Records reviewed includes Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, and Needs and Services Plan. Safe sleep information for infants was provided and reviewed with Director.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KIDS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434410624
VISIT DATE: 10/29/2019
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
26
27
28
29
30
31
32
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. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR and First Aid present at the facility during LPA's inspection.

LPA 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.

LPA also reviewed with Director the violations that would result in an immediate $500 civil penalty assessment. Faciltiy is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.ca.gov] to access resources for Providers, Regulations 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. A copy of the the Effect of Lead Exposure flyer was provided to facility.

Incidental Medical Services (IMS) policy was discussed. Director stated that currently there are no children in care who requires the administration of medication.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.

In the areas that were evaluated, regulatory violations were observed at the time of the inspection. Exit interview was conducted, where this report, the violations, plan of corrections, and appeal rights were reviewed 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: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KIDS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434410624
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2019
Section Cited

1
2
3
4
5
6
7
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 LPA's review of 8 infant files,
8
9
10
11
12
13
14
Licensee failed to update 7 out of 8 Infants' Needs and Services Plan at least quarterly. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14
Type B
11/12/2019
Section Cited

1
2
3
4
5
6
7
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 today's (10/19/19) Sign In/Out record, Licensee failed to ensure that 4 infants who are present during
8
9
10
11
12
13
14
the inspection are signed in. This poses a potential risk to the health & safety of children in care.
8
9
10
11
12
13
14
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: 10/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3