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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434410624
Report Date: 10/20/2020
Date Signed: 10/21/2020 08:02:05 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/05/2020 and conducted by Evaluator Tuoc Doan
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20200805115210
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: 0DATE:
10/20/2020
UNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Shani SolomonTIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Neglect/Lack of supervision resulting in child sustaining injury while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuoc Doan conducted a subsequent Tele-investigation via video call with Director Shani Solomon. LPA informed Director of the purpose of the video call and the finding for the allegation above was delivered to the facility. LPA explained to Director that due to the COVID-19 pandemic and "Shelter in Place" Order, this LIC9099 Complaint Investigation Report was generated at the Licensing Office and will be emailed to the facility. Facility's reply to the email will serve as acknowledgement that the report was received.

Complainant alleges that a child sustained an injury due to staff's neglect/lack of supervision. LPA inspected the facility. Interviews were conducted with staff and parent. Records pertaining to the case, which included Facility, Children and Staff files, and medical reports were also obtained and reviewed.
Based on the information obtained, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore, the allegation is found to be UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 07-CC-20200805115210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/20/2020
NARRATIVE
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 Exit interview was conducted, where this report was reviewed with Director over the video call.

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: 10/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2