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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414778
Report Date: 12/09/2021
Date Signed: 12/09/2021 11:02:44 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 UNIDOSFACILITY NUMBER:
434414778
ADMINISTRATOR:LISETTE MEJIAFACILITY TYPE:
850
ADDRESS:1970 CINDERELLA LANETELEPHONE:
(408) 471-6399
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:48CENSUS: 28DATE:
12/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Josefina Garcia, Site DirectorTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA), James Santos arrived at the facility today to conduct a case management visit. LPA met with Site Director, Josefina Garcia.

The purpose of the case management visit was in regards to an incident that the Site Director self reported to the Department that occurred on December 7, 2021. Per Director, there were three (3) parents waiting in line to pick up their children and sign them out from the classroom (Room 156) when one of the child left the classroom at some point and was observed playing by himself in the playground area by a parent and was brought back to the classroom. Per report, the incident occurred between 3:34 PM and 3:39 PM during pick up time. There were six (6) preschool children and three (3) teachers in the classroom at the time of the incident.

Site Director stated that she will submit the Unusual Incident Report to the Department upon approval by management.

During today's visit, LPA also obtained a copy of the children's roster and sign in/out sheet.

Due to insufficient information at this time, this case management will need further investigation. No deficiencies cited during today's visit.


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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021
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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