434412724-7-3-2019-07-CC-MMOO-BDQSJS-20190703135536

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412724
Report Date: 07/03/2019
Date Signed: 07/03/2019 01:55:41 PM

COMPREHENSIVE INSPECTION

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:	KIDDIE ACADEMY OF CUPERTINO		FACILITY NUMBER:	434412724
ADMINISTRATOR:	XIONG, ANGELA		FACILITY TYPE:	840
ADDRESS:	19875 STEVENS CREEK BLVD		TELEPHONE:	(408) 517-0454
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	22	CENSUS: 18	DATE:	07/03/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:36 AM
MET WITH:	Leian Baldoza		TIME 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), Marilou Monico, met with Acting Site Director, Leian Baldoza, and conducted an annual random inspection. The facility utilizes Room 6 for the school age program. LPA observed all required posted materials: License, Parent’s Rights, Emergency Disaster Plan, menus, Earthquake Preparedness Checklist, Child Passenger Safety Law, and activity schedule. The facility was toured inside and outside. The facility observed to be clean, safe, and in good repair. Disinfectants, cleaning solutions, and all other items that are dangerous to children were observed to be securely stored and inaccessible to children. Furniture and equipment were age-appropriate and in good condition. Restroom for children’s use were observed to be sanitary and operable. Trash cans used for the disposal of solid waste have tight fitting lids. Drinking water indoor is via pictures, cups, and drinking fountains. Acting Site Director states that there are no weapons on the premise. LPA observed functioning carbon monoxide detector and smoke detectors. LPA did not observe any bodies of water. LPA reviewed four random children's files and two staff files. Acting Site Director has current CPR/First Aid certification with an expiration date of June 1, 2021. The facility provides snacks and lunch to the children in care. There is a kitchen at the facility for food preparation. The kitchen was observed to be clean and sanitary. The kitchen is equipped with microwaves, stove, oven, refrigerators, dishwasher, and a sink with hot and cold running water. LPA observed adequate food for snacks and lunch. There are climbing structures on the playground with rubber foam as resilient material. Shade is provided by canopies. Drinking water outdoor is provided through drinking fountains. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 07/03/19):

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019

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: KIDDIE ACADEMY OF CUPERTINO	FACILITY NUMBER: 434412724
	VISIT DATE: 07/03/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/03/19)

Staff present during the inspection have cleared criminal record and child abuse index clearances or exemptions. LPA also reminded Acting Site 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. Penalty amounts: minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

LPA discussed Senate Bill 792, AB 633, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporter Training) which is required training that began on January 1, 2018 and requires renewal every two years with Acting Site Director. Licensing forms, Title 22 regulations, can be obtained through the internet at ww.ccld.ca.gov. Mandated Reporter Training can be accessed at www.mandatedreporterca.com. LPA discussed and provided Acting Site Director a copy of lead safety information and advised her to provide copies to parents.

This facility provides Incidental Medical Services – IMS. IMS Plan is on file. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

As a result of this inspection, there were no deficiencies cited.

A NOTICE OF SITE VISIT WAS ISSUE AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019

LIC809 (FAS) - (06/04)

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