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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406690
Report Date: 01/24/2025
Date Signed: 01/24/2025 10:12:31 AM

Document Has Been Signed on 01/24/2025 10:12 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KIDZ ACADEMY, INC.FACILITY NUMBER:
434406690
ADMINISTRATOR/
DIRECTOR:		CAROLYN MENDOZAFACILITY TYPE:
850
ADDRESS:1224 NORTH WINCHESTER BLVDTELEPHONE:
(408) 261-9523
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY: 43TOTAL ENROLLED CHILDREN: 43CENSUS: DATE:
01/24/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:22 AM
MET WITH:Carolyn MendozaTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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Licensing Program Manager (LPM) Belinda Devall, and Licensing Program Analyst (LPA), Mandeep Kaur met with Director, Carolyn Mendoza at the San Jose Child Care Regional Office.
The purpose of this meeting was to discuss a recent violation of Title 22 regulations, that posed an immediate and potential risk to the health, safety, and personal rights of children in care during the complaints investigations.

The following violations were discussed:

Type A Deficiency:

On July 30, 2024, the facility was cited for 101229(a)(1) - Responsibility for Providing Care and Supervision.

Based on the complaint investigation comprising of interviews and evidence gathered in relation to neglect/lack of supervision, the facility was cited for two children found outside of the facility without adult supervision. A child care center shall ensure no child(ren) are left without the supervision of a teacher at any time. Supervision shall include visual observation.

Type B Deficiency:



On November 13, 2024, the facility was cited for 101223(a)(3) - Personal Rights.

Based on the complaint investigation comprising of interviews and evidence gathered in relation to neglect/lack of supervision, the facility was cited for a staff member has elevated her voice in frustration to children in care multiple times. Each child receiving services shall be afforded their personal rights, including but not limited to free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including, but not limited to: interference with eating, sleeping or toileting; or withholding shelter, clothing, medication or aids to physical functioning and accorded dignity in his/her personal relationships with staff and other persons.

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SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/24/2025
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KIDZ ACADEMY, INC.
FACILITY NUMBER: 434406690
VISIT DATE: 01/24/2025
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LPM Devall explained child care center personnel shall provide the services necessary to meet the individual needs of children in care and personnel shall be given on-the-job training in provision of child care and supervision, including communication which shall be demonstrated by safe and effective job performance.

LPM Devall and Director discussed providing additional resources to continue to support the facility with compliance for providing care and supervision. This includes possible training to assist staff with assessing the risk and minimizing the harm to children in care based on various scenarios that may occur in the facility.

LPM Devall explained to Director that if there are continued deficiencies cited for the issues noted on this report or any other risks to the health and safety of children in care, the facility may be referred to the Department's legal department for possible administrative action, which could include revocation of the facility license. The facility will be monitored more frequently to ensure that the facility is in compliance with the Department regulations.

LPM Devall discussed the requirements of AB 633 with the Director and provided the AB 633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and the Director understands the requirements.

SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC809 (FAS) - (06/04)
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