434406754-12-20-2022-07-CC-SCOS-CMARYP-20221220122640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434406754
Report Date: 12/20/2022
Date Signed: 12/20/2022 12:26:51 PM

Document Has Been Signed on 12/20/2022 12:26 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	KIDANGO GOSS CENTER		FACILITY NUMBER:	434406754
ADMINISTRATOR:	KELLY ARANA		FACILITY TYPE:	850
ADDRESS:	2475 VAN WINKLE LANE		TELEPHONE:	4083530528
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95116
CAPACITY:	22	CENSUS: 12	DATE:	12/20/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Kelly Arana		TIME COMPLETED:	12:45 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	Page 1 Licensing Program Analyst (LPA), Stephanie Collins, conducted an unannounced annual inspection of the Preschool. LPA met with Director Kelly, Arana and informed her the purpose of the visit. LPA arrived at the facility at 8:45 A M Notification of Parents’ Right Poster, Children's Personal Rights, Child Car Seat Laws, Child Care License, LIC 610 Emergency Disaster Form (1and 2), LIC 308 Designation of Responsibilities, and menu were observed to be posted. Facility’s operating days and hours are Monday- Friday 08:00 AM to 11:00 PM and 12:00 PM to 3:00 PM. During visit, LPA observed a ratio of 12 children to 3 staff. All staff present on site are associated to the facility. Facility representative Kelly Arana 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. LPA inspected the building inside and out with Director Kelly Arana. The Preschool is located in Classroom/Portable 79 of a functioning school site (Goss Elementary School ). The Preschool classroom, restroom for children to use and office area, storage area, food storage areas were inspected. Furniture and equipment were observed to be age appropriate and in good condition, free of sharp, loose, or pointed parts. Restroom for children to use were observed to be in operating conditions. There are separate staff rest rooms located within the school grounds. There is a designated area in the portable which sick children can utilize if isolation is required.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KIDANGO GOSS CENTER	FACILITY NUMBER: 434406754
	VISIT DATE: 12/20/2022

NARRATIVE

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Disinfectants, cleaning solutions, poisons, sharps, and other items that are dangerous to children were stored inaccessible. Facility provides two meals breakfast and lunch. Meals are prepared and packaged by the facility's "Nutritional Department," which is off site, and then deliver to the facility. LPA observed that food storage areas were clean, free of litter, rubbish, and rodents/vermin. Foods and beverages were kept protected against contamination and spoilage. Trash cans for solid waste had tight-fitting covers on.

The Preschool holds a waiver to use the Elementary School Kindergarten play yard) however primarily uses its own play yard, which is enclosed by fence. Activity schedule was posted. LPA observed play equipment were maintained in a good condition, free of hazards. Areas around and under high climbing equipment were cushioned with material that absorbs falls. There were no bodies of water observed. Director stated that facility does not have weapons on the premises. Drinking water is arranged to be readily available to children. Shade is provided by trees, building overhang, etc. First Aid kit was inspected. Smoke and carbon monoxide detectors was observed and a fully charged fire extinguisher.

Log recorded that the last fire/disaster and earthquake drill was conducted on(11/16/2022). LPA reviewed facility's sign in/out procedure and record.

A sampling of children and staff files was selected for review. Children records reviewed includes: Admission Agreement, Identification and Emergency Information, Consent for Emergency Medical Treatment form, Medical Assessment, and immunization.

Staff records reviewed include: Criminal Record and Child Abuse Index Background Check Clearance, Health Screening Report with TB Clearance, Immunization Record for Measles and Pertussis, Education Qualification, and required Training. LPA reminded Director that the AB1207 Mandated Reporter Training needs to be renewed every two years. There was at least one person with documented current certification in Pediatric CPR/1st Aid present at the facility during LPA' inspection. Fees current.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KIDANGO GOSS CENTER	FACILITY NUMBER: 434406754
	VISIT DATE: 12/20/2022

NARRATIVE

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This facility provides Incidental Medical Services – currently the facility does not have any children in care who requires IMS. 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.

LPA reviewed with Director the violations that would result in an immediate $500 civil penalty assessment. Director is encouraged to visit the Department’s website at www.cdss.ca.gov [Shortcut: ccld.ca.gov] to access resources for Providers, Regulations etc.

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/process.

In the areas that were evaluated, no regulatory violations were observed at the time of the inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative Kelly Arana.

SUPERVISOR'S NAME: Gladys Kuizon	TELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022

LIC809 (FAS) - (06/04)

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