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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414507
Report Date: 06/11/2019
Date Signed: 06/11/2019 04:35:10 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:KIDANGO DORSAFACILITY NUMBER:
434414507
ADMINISTRATOR:LINDA MARIE AGUILARFACILITY TYPE:
850
ADDRESS:1290 BAL HARBOR WAY #P1TELEPHONE:
(408) 429-2689
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:24CENSUS: 0DATE:
06/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Linda Marie AguilarTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA), Stephanie Rangel conducted an annual random inspection and a case management investigation for an unusual incident that occurred on 5/22/19. During the unusual incident, a teacher was transported to a hospital while two teacher's aids supervised children prior to pick-up.

LPA met with Site Director, Linda Aguilar, and explained the nature of today's inspection. There is one classroom licensed for the preschool program and the classroom is clean and safe for children. At least one staff member has current CPR/First Aid certification. Five children's files and 3 staff files were reviewed. Drinking water indoor is via pitchers and plastic cups. The center provides snacks and breakfast and lunch. The food preparation is equipped with refrigerator, microwave, and hot and cold running water. LPA observed adequate food for the children. LPA observed trash cans that are used as disposal of solid waste. Children's bathrooms are sanitary and operable. Site Director states that the facility has a third-party cleaning service that comes in the evenings to clean. There is at least one functioning carbon monoxide detector at the facility. Site Director states that there are no weapons on the premises.

On the preschool playground, LPA observed tan bark as resilient material under the playground equipment. Shade is provided by canopies and trees. LPA did not observe any bodies of water. Drinking water outdoor is via water pitcher and disposable water cups.

LPA discussed Senate Bill 792, Assembly Bill (AB) 1207 (Mandated Child Abuse Reporting Training) which is required training that began on January 1, 2018 and requires renewal every two years, AB 633 was discussed with Site Director. Licensing forms, Title 22 regulations, can be obtained through the internet at www.ccld.ca.gov. Mandated Reported Training can be accessed at www.mandatedreporterca.com.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 6/11/19):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
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: KIDANGO DORSA
FACILITY NUMBER: 434414507
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2019
Section Cited
CCR
101216.2(e)
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Teacher Qualifications and Duties:
An aide shall work only under the direct supervision of a teacher. This requirement was not met as evidenced by during a review of staff files, LPA viewed that two teacher's aids were at the facility to watch children when a teacher needed to leave for the hospital. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Site Director stated that the school will make sure there be enough qualified staff at the center.
Proof of correction to be sent to CCL by POC due date.
Type B
06/18/2019
Section Cited
CCR
101216.3(c)
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Teacher-Child Ratio: Child development programs funded by the California Department of Education and operating under Title 5 of the California Code of Regulations are not required to meet the teacher-child ratios specified in (a) and (b) above. Title 5 staffing ratios shall apply in such centers.
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Site Director stated that the school will make sure there is enough qualified staff at the center.
Proof of correction to be sent to CCL by POC due date.
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This requirement was not met as evidenced by during a review of sign/in sign/out sheets, LPA viewed that there were at least 18 children at the center with two teacher's aids when another teacher needed to leave for the hospital. This poses a potential risk Health, Safety Personal Rights risk to 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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
Page: 3 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: KIDANGO DORSA
FACILITY NUMBER: 434414507
VISIT DATE: 06/11/2019
NARRATIVE
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 6/11/19):

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and 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.

A review of staff records during today's inspection indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded 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: $100.00 per person per day, 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 violations within a 12 month period.



As a result of this inspection, deficiencies cited on the following page. Appeal rights printed and reviewed.

Effects of Lead Exposure handout given during today's inspection. Site director understands that it is to be given out to newly enrolled and re-enrolled families.

NOTICE OF SITE VISIT WAS POSTED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3