434415706-10-5-2021-07-CC-AMOS-C7HLF9-20211005084247

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415706
Report Date: 10/04/2021
Date Signed: 10/05/2021 08:42:54 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 FOXDALE		FACILITY NUMBER:	434415706
ADMINISTRATOR:	THAO NGUYEN		FACILITY TYPE:	830
ADDRESS:	1250 FOXDALE LOOP		TELEPHONE:	(408) 290-7666
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95112
CAPACITY:	16	CENSUS: 7	DATE:	10/04/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Thao Nguyen		TIME COMPLETED:	01:20 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	(#1) Licensing Program Analysts (LPA's) Anna Morales and Aman Sharma conducted an ANNUAL REQUIRED VISIT. LPA's were greeted by Director Thao Ngueyn. Facility's License, Notification of Parents’ Rights Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, and Earthquake Preparedness Checklist were observed to be posted. The center's operating hours are Monday through Friday from 7:00am- to 05:00.PM. Age serve is 18 months to 24 months. The Infant Program is operating in Room 167. The children in the Infant Program use Infant/Toddler Playgrounds which is located outside the patio of the classroom. Also, there is another playground that is located outside the building. The center is located surrounded by an apartment complex. The Director stated that the playground is shared with the children who reside in the apartments, but it is not used by the apartment complex while the children from the center are utilizing it. LPA's are requesting the Director to submit a waiver for the shared playground (with the apartment) along with a schedule. LPAs toured the facility both indoor and outdoor. LPAs observed that the facility was operating in compliance with teacher to children ratio requirement. The children were engaged in activities. There were no bodies of water observed. Director stated that the facility do not have weapons on the premises. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, and other items that are dangerous to children were stored inaccessible to children. Floors were clean. (page 1)

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

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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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 FOXDALE	FACILITY NUMBER: 434415706
	VISIT DATE: 10/04/2021

NARRATIVE

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Outdoor activity spaces are enclosed by fencing and are observed to be free of hazards. LPAs observed play equipment were in good condition. Drinking water was readily available to children indoor and outdoor. Activities schedule and Menu were posted. Facility provides lunch and snacks (morning and afternoon). Lunch and snacks are prepared at the facility. LPAs observed that food storage areas were clean and free of litter. LPAs observed that each infant has current feeding and diaper log. Diapers are being disposed appropriately. Each infant has personal items individually stored and labeled.

Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on, and were in good repair. Fire extinguisher, smoke and carbon monoxide detectors were observed.
This facility is providing Incidental Medical Services – IMS Plan. Director stated that there are children currently enrolled are using medication.

LPAs reviewed sign in and out record, and procedure. A sampling of children and staff files was taken for review during today's inspection. Children records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Medical Assessment, Immunization, and Infant Needs and Services Plan.

Staff records reviewed include Criminal Record and Child Abuse Index Clearance, Health Screening Report and TB test, Immunization (Measles, Pertussis, and Flu) record and required Training. LPAs reminded Assistant Director that the online AB1207 Mandated Reported Training needs to be renewed every two years. There was at least one person with current certification in Pediatric CPR and First Aid present at the facility.

LPAs reminded 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. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day up to $3000.00 per person.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

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 FOXDALE	FACILITY NUMBER: 434415706
	VISIT DATE: 10/04/2021

NARRATIVE

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LPAs also reviewed with the Director the violations that would result in an immediate assessment of civil penalty in the amount of $500. The Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

In the areas that were evaluated, there were no deficiencies cited.

A discussed the requirements of AB 633 with the Licensee. The Director understands the AB 633 fact sheet/copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224). LPA discussed "zero tolerance" related regulations with the Director and advised the Director of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $100 per day continues until the violation(s) is corrected.

LPA's conducted an exit interview with the Director. LPA's discussed and left a copy of Pin 20-24-CCP, RECENTLY APPROVED SAFE SLEEP REGULATIONS IN EFFECT. Discussed that all INFANTS UP TO 12 MONTHS OF AGE MUST HAVE AN INDIVIDUAL INFANT SLEEPING PLAN (LIC9227) OF FILE, WHICH WILL DOCUMENT THE INFANTS SLEEPING HABITS, USUAL SLEEPING ENVIRONMENT, AND THE INFANT ROLLING ABILITIES. PROVIDERS MUST CONDUCT CHECKS EVERY 15 MINUTES ON SLEEPING INFANTS (UP TO AGE 2 ).

A Technical Violation (LIC9102) was issued at today's visit.

A copy of this report was provided to the facility at the conclusion of the inspection.

NOTICE OF SITE VISIT WAS ISSUED. ASSISTANT DIRECTOR WAS INFORMED TO POST THE NOTICE IN A VISIBLE LOCATION OF THE DAY CARE FOR A PERIOD OF 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC809 (FAS) - (06/04)

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