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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414074
Report Date: 03/12/2020
Date Signed: 03/12/2020 11:38:04 AM

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:KIDANGO EDEN PALMS INFANTFACILITY NUMBER:
434414074
ADMINISTRATOR:MICHELLE PALACPACFACILITY TYPE:
830
ADDRESS:5398 MONTEREY RDTELEPHONE:
(408) 200-2910
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:9CENSUS: 5DATE:
03/12/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Michelle PalacpacTIME COMPLETED:
11:55 AM
NARRATIVE
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Licensing Program Analysts (LPA) Dung Mac conducted an unannounced annual inspection to the facility today. LPA met with Site Director Michelle Palacpac at 8:50am, and explained the nature of today's visit. Facility also has a Preschool program (#434414073) on the same premises.

LPA toured the Facility at 9:05am. LPA did not observe any bodies of water. Michelle stated there are no weapons or firearms on the premises. LPA observed the facility is clean and safe for children. LPA observed cleaning supplies are inaccessible to the children. LPA observed all furniture and equipment is in good condition and safe for the children. LPA observed solid waste containers have tight-fitting covers and in good condition.

LPA observed that there is one functioning carbon monoxide in classroom. LPA observed that the teacher/child ratio was in compliance during today's visit. Children's bathrooms are clean and sanitary. Drinking water is readily available for indoor and outdoor. LPA observed the required materials posted in classroom. Meals and snacks are prepared in central location and delivered to the facility.

LPA observed the surface of outdoor activity space is maintained in a safe condition and free of hazards. LPA observed that the outdoor equipment is age appropriate and in good condition. Michelle stated that no medication is administered at this time.

LPA reviewed children and staff files at 9:51am Staff and children files are complete. All staff have current CPR and First Aid certifications on file. LPA observed a copy of Admission Agreement in each child's file.

LPA conducted an exit interview with the Michelle. No deficiencies were cited during visit. A Notice of Site Visit was issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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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