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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434410624
Report Date: 11/10/2020
Date Signed: 11/10/2020 03:00:17 PM



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
07/27/2020 and conducted by Evaluator Tuoc Doan
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20200727140814
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:
11/10/2020
UNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:Shani SolomonTIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Facility is operating out of ratio.
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 there were a few times a Teacher Aide was working by herself in the infant classroom. The investigation provided sufficient evidence and corroborating information to establish that the Infant Center was operating out of ratio multiple times in July 2020. Both Director and Corporate Officer admitted that there were times a Teacher Aide was working by herself with the infants. Personnel records that documented the hours staff actually worked show that there were times in July 2020 where the facility only had enough Teachers to either cover the ratio for their Preschool or Infant Center, but not both.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020
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 3
Control Number 07-CC-20200727140814
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: 11/10/2020
NARRATIVE
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This is in violation of Title 22 Regulations requirement that an aide shall work only under the direct supervision of the Teacher.

Based on the information obtained, the preponderance of evidence standard has been met. Therefore, the allegation that Facility was operating out of ratio in July 2020 is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on the next page.

Exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were 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: 11/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 07-CC-20200727140814
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/10/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/10/2020
Section Cited
CCR
101216.2(e)
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TEACHER AIDE QUALIFICATIONS AND DUTIES. An aide shall work only under the direct supervision of a teacher.
This requirement is not met as evidenced by:
Based on information obtained from LPA’s review of personnel records and interviews with Director, Corporate Officer and Staff,
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This deficieny has been corrected.
Licensee decided to close the Infant Center after 07/31/2020 and plans to reopen ony when Licensee can secure a qualify Infant Teacher to cover the ratio for the Infant Center at all times.

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there were times in July 2020 that Teacher Aide Cindy Portillo was not under the direct supervision of a Teacher when she was working and caring for 3 to 4 infants. This poses a potential risk to the health and safety of children in care.
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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: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3