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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434403618
Report Date: 06/29/2021
Date Signed: 06/29/2021 02:29:57 PM

Document Has Been Signed on 06/29/2021 02:29 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:KINGDOM KREWFACILITY NUMBER:
434403618
ADMINISTRATOR:VALORIE WILLIAMSFACILITY TYPE:
840
ADDRESS:1730 CURTNER AVENUETELEPHONE:
(408) 264-2811
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 116TOTAL ENROLLED CHILDREN: 0CENSUS: 32DATE:
06/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Valorie WilliamsTIME COMPLETED:
11:18 AM
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Licensing Program Analysts (LPAs) Samantha Yip and Ofelia Calivo conducted an unannounced Case Management-Other. LPAs met with Director Valorie WIlliams and explained the reason for the inspection. The purpose of this inspection was to follow up on an incident that occurred on 02/27/2020 involving supervision.

LPAs discussed with Director about plans that have been implemented. Director stated that all staff who transport children walk to the back of the vehicle to ensure all children are exiting the vehicle, then will do head count outside of the vehicle and when they drop off children at their designed room. Director also stated that staff are required to conducted training through DMV and CHP. She also stated that all the vehicles will have a button installed at the back of the vehicle to ensure that all staff transporting children are checking the vehicle prior to exiting. Director will also be conducting staff training on 08/16/2021 and 08/17/2021 in regards to supervision and transportation.

As a result of this inspection, no deficiencies have been cited. An exit interview was conducted where this report was discussed and provided to Director Valorie Williams. A Notice of Site Visit has been issued and must be posted for 30 days.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2021
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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