434416144-6-8-2021-07-CC-MSEA-C3VSFE-20210611135014

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434416144
Report Date: 06/08/2021
Date Signed: 06/08/2021 04:10:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2021 and conducted by Evaluator Araceli Almaraz

COMPLAINT CONTROL NUMBER: 07-CC-20210506152619

FACILITY NAME:	KIDANGO SANTA TERESA		FACILITY NUMBER:	434416144
ADMINISTRATOR:	ANGELICA CARDENAS		FACILITY TYPE:	850
ADDRESS:	6150 SNELL AVENUE		TELEPHONE:	(408) 928-5270
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	24	CENSUS: 13	DATE:	06/08/2021
		UNANNOUNCED	TIME BEGAN:	01:42 PM
MET WITH:	Salazar, Alyssia		TIME COMPLETED:	04:23 PM

ALLEGATION(S):

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Staff not logging/changing diaper/s as needed.

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Almaraz, Celi conducted an on site complaint investigation inspection. LPA met with Director Salazar, Alyssia. The purpose of today's inspection: To deliver investigation findings.

LPA interviewed Director, staff and reviewed supporting documents. This agency has investigated the complaint/s alleging "Staff not changing diaper/s as needed" and “Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12 & Chapter 1, 101229 (A), is/are being cited on the attached LIC. 9099D.”

An exit interview was conducted with Director. LPA informed Director that this report, appeal rights, and notice of site visit have been emailed and printed.

There was one Type B deficiency cited during today's inspection. Notice of site visit issued and must remain posted for consective 30 days.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 07-CC-20210506152619

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 SANTA TERESA	FACILITY NUMBER: 434416144
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/08/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/11/2021 Section Cited CCR 101229(A)	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement was not met as evidenced by based on interviews child/ren left facility in soiled diapers.	1 2 3 4 5 6 7	Director will send a schedule and log how facility will keep diaper changing and accident records. This will be sent on or before 06/11/2021 via email to LPA.
	8 9 10 11 12 13 14	The facility failed to keep logs of diaper changing intervals. This poses a potential a risk to the healthy and safety of the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli Almaraz	TELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

LIC9099 (FAS) - (06/04)

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