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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415706
Report Date: 10/14/2022
Date Signed: 10/14/2022 03:55:30 PM


Document Has Been Signed on 10/14/2022 03:55 PM - It Cannot Be Edited

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 FOXDALEFACILITY NUMBER:
434415706
ADMINISTRATOR:THAO NGUYENFACILITY TYPE:
830
ADDRESS:1250 FOXDALE LOOPTELEPHONE:
(408) 290-7666
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY:16CENSUS: 7DATE:
10/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nguyen, ThaoTIME COMPLETED:
04:15 PM
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On this day Licensing Program Analyst/s (LPA/s) Almaraz, Celi conducted an unannounced annual random inspection. Due to COVID- 19 precautionary measures were taken and protective equipment was worn. This facility is currently licensed for a capacity of 16, ages 6 to 24 months. Licensing staff met with Director Nguyen, Thao and explained the nature of today’s inspection. This is an infant program that currently operates from 7AM to 5 PM, Monday thru Friday, closed at 1:30 PM every other Friday (including this day). Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of this visit, there is a total census of 7 children and a total census of 4 staff, teachers and/or assistants present, including director.

Director states that there are currently 15 children enrolled. This is a double component facility, there is a preschool program 434415705 on campus. This program currently accepts children from 18 to 36 months. LPA and Director discussed that the program is currently operating out of the scope of the license, which is licensed for children from 6 to 24 months. LPA discussed regulations 101216.4, 101417 (a) & 101151 all addressing limitation and components.

Physical Plant: This an infant program which consists of the following classrooms: One classroom, Class 167. All areas identified on the Facility Sketch were inspected. LPA/s observed the following:

Classroom 167. Staff # 1 thru 3 three fully qualified teachers with 7 children. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to four sinks, two toilets. LPA observed that all items that may pose a threat to children are placed out of reach of children. 1/6

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 10/14/2022
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All classrooms observed to have suitable furniture and equipment, which were inspected for age appropriateness. All classrooms observed to have sufficient telephone services, heating, lighting, and ventilation.

General sanitization & safety items: Children have their own cubby to store their belongings. Per Director, sick children are isolated in the director's office. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. LPA observed trash bins have foot petals to open. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care. Director states that poisons are kept with the custodian.

Kitchen: All kitchen areas/food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition. Water and refrigerator temperatures in standard condition. Director states waste is to be discarded immediately after each meal.

Food: Menus are posted on line one week in advance for the month, in each classroom and are emailed or texted to parents upon request. Menus for the past one year are available upon request. Snacks (PM), breakfast and lunch are provided. Per Director facility is with a food program, CACFP, and were reviewed for availability, quantity and appropriateness to children in care. Per Director, all meals are prepared daily at the head office and transported to facility. Snacks and supplemental food with 5 components kept on site. Per Director there is an allergy list for each child posted in kitchen area. There are also index cards, with child’s name and allergies kept classroom, on cabinet door. There is no food brought from home.

Lavatories: Classroom 167 has access to 4 sinks, 2 toilets. Staff uses an extra lavatory in this room, this is also used for sick child if needed. There are currently no potty trained children in care. 2/6

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
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: 10/14/2022
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Medical & First Aid Supplies: There is a first aid kit in the classroom. LPA reviewed kit to ensure supplies are complete. Director states that supplies are checked every month, every four months a health and safety package is sent, the emergency supplies are also checked at this time. Per Director medication is only administered to a child when accompanied with a doctor's note, parent plan, authorizations are to be completed monthly. The medication is kept in an emergency backpack, which is stored out of reach.

Per Director there is currently one child enrolled who requires Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Fire & Safety: Carbon monoxide detectors and smoke detectors are working and present in the facility, the fire department conducted a fire inspection on 10/10/22. There are Fire extinguishers, size 3A40BC in each room, last serviced 04/11/2021; last fire drill was conducted on 09/09/2022, Director understands this is to be completed every six months.

Matts and cots: Cots inspected for napping were observed to be maintained in a safe condition with no exposed foam. Constructed of material at least 3/4 inch thick. Covered with vinyl or similar material that can be wiped. Designed so that the sleeping side can be distinguished from the floor side. Per Director cots are wiped with a detergent/disinfectant weekly or when soiled or wet. Each cot observed to be equipped with a sheet and/or blanket to cover the child. Per Director bedding is not shared and is washed onsite each Friday (or when soiled) to be laundered. LPA reminded Director that bedding shall be individually stored so that each child's bedding is identifiable, and no child's used bedding shall meet other bedding. Blankets are sent home each Friday to be washed. Bedding is stored on top of each cot, so as not to touch. 3/6

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
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: 10/14/2022
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LPA/s discussed the sleeping equipment for infants. LPA/s explained that there must be cribs for each infant and infant must be unable to climb out of the crib or play yard. All equipment must meet the US Consumer Product Safety Commission safety standards. Please see www.safekid.org for a list of any recalled products. LPA/s explained that cribs must be free from loose articles and objects. There must be no objects hanging above or attached to the side of the cribs. LPAs explained that play yards must not hinder the entrance or exit to and from the space they are sleeping in. Mattresses must be firm and covered with a fitted sheet that is appropriate to the mattress size. Each infant must have their individual bedding and washed weekly or as required. Soiled bedding must be replaced when wet or soiled and placed in an area inaccessible to infants. Pacifiers must not be attached to anything. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping. A LIC 9227 must be kept in each file. Breathing must be checked and documented every 15 minutes. There must be visual supervision, at all times. LPA went over regulation 101439 and 101429 with Director for infant sleep and supervision requirements.

Outdoor Playground: Equipment is in safe condition, free of sharp, defective or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. This facility is in Foxdale apartment village complex, main building is shared with leasing office. Resident children have access to playground on the weekends. There is one playground for children in care. There is also a patio, please see waiver section of this report. There is a locked storage shed in patio area, where play equipment for the children is kept.



Facility Records: LPA/s issued Review of Staff records (LIC 859) to the Director during this inspection. At least one staff (Director) has record of CPR and First Aid, valid until 01/15/2024. All staff present have the following: MMR & Tdap vaccinations, flu vaccine or the opt out. All staff has completed Mandated Reporter Training, Directors is valid thru 2024. Director understands this must be renewed every two years. LPA/s reviewed 2 children's files and issued an LIC 857. LPA reviewed 3 staff files. All files were observed to be complete. 4/
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
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: 10/14/2022
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Sign in and out: Procedures were reviewed by LPA/s to ensure that children who are present where signed in. Facility uses an electronic sign in/sign out system. LPAs obtained a roster and personnel report at the conclusion of this inspection.

Waivers: There are two waivers on file both for outdoor activity space, including the patio, which requires the following: 1. No more than 15 children shall be in the playground at once. 2. Playground and patio schedules must be posted in the classroom. 3. No other programs shall be commingling. 4. Staff/child ratio must be complied with at all times. Director states playground is not locked from the inside, due to being shared with apartments. Director states there is always a teacher posted by the door to ensure supervision. Director states that patio shall never exceed 8 children at any time. LPA observed facility has complied with all terms of this waiver. There is also a centralized fingerprint primary facility waiver, facility # 434404854, in accordance with section 101175, facility is in compliance.

LPA advised Director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. For commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Postings: Parent’s Rights Poster (with complaint Hotline) was observed during this inspection. LPA observed all required postings, including license and emergency disaster plan.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

Director understands : SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative. .5/6

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7
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: 10/14/2022
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AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

Lead Testing: Director states a lead sample was collected by a certified external water sampler on 10/14/2022, and results will be back within 2 weeks. Director understands providers must submit the LIC 9275, a completed signed and dated child care sampling checklist form LIC9276 and a facility sketch LIC 999 fully labeled with locations of all water outlet to their LPA.



LPA asked Director to submit an application for a toddler component the following information: 1. LIC 200. 2. Handbook. 3. Admissions agreement. 4. Needs and Services plan. 5. Per Director there is parental consent for children to attend program over 24 months. Must be submitted this department within ten calendar days of this report.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The following was discussed:


· Reporting Requirements.
· The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations.
· All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties. All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions.
LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

There are two type B deficiencies being cited in accordance to Title 22 of the California Code of Regulations and Health & Safety codes. A notice of site visit was given and must remain posted for 30 days.Exit interview conducted and report was reviewed with facility representative, 6/6
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 10/14/2022 03:55 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type B
Section Cited
CCR
101161


This requirement is not met as evidenced by: (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.
Deficient Practice Statement
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Based on observation, interviews and record review, the licensee did not comply with the section cited above, the program enrolls children from 18 months to 36 months old, the license is approved for 6 months to 24 months, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 10/24/2022
Plan of Correction
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Licensee/Director will submit a request for a toddler option license including the following: 1. LIC 200. 2. Updated handbook. 3. Updated Admission Agreement. 4. Updated needs and services plan. 5. Proof of written permission for all children to attend school within the scope of this age group and license.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2022
LIC809 (FAS) - (06/04)
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