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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406756
Report Date: 11/02/2022
Date Signed: 11/02/2022 02:25:42 PM

Document Has Been Signed on 11/02/2022 02:25 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 HUBBARD CENTERFACILITY NUMBER:
434406756
ADMINISTRATOR:GAMBOA, MARTHAFACILITY TYPE:
850
ADDRESS:1680 FOLEY AVENUETELEPHONE:
(408) 353-0559
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 12DATE:
11/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gamboa, MarthaTIME COMPLETED:
02:45 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. This facility is currently licensed for a capacity of 40. Licensing staff met with Director Gamboa, Martha and explained the nature of today’s inspection. This is a preschool program that currently operates from 7:30 AM to 4:00 PM, Monday thru Friday. This is an AM/PM half day program. Children are in care for 3 to 4 hours per 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 was a total census of 12 preschool children and a total census of 4 staff, including Director, that were present. This is a single component facility on Hubbard Elementary School campus. This is a special needs inclusion program, where Special needs children from the Alum rock School district also attend this facility. Per Director district children have double registration, files on site, needs and service plans. Facility fully responsible for children while in care. Three school district staff were also present to assist with case load. Per Director, staff are finger print cleared through district.

Physical Plant: All areas identified on the Facility Sketch were inspected. This preschool program which consists of the following classrooms: Room 83 & Room 82. LPA observed the following: Room 83: There were Staff # 2, 3 fully qualified teacher and 8 preschool children. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to 2 sinks inside each classroom. There is a hall that connects the two rooms, which hosts a centralized lavatory area for the children in care. Room 83 & 82 are adjacent to one another. Room 82: There was Staff # 4 a fully qualified teacher with 4 preschool children. Teacher child ratios were observed, and staff names recorded. Personal rights observed. The three school district staff attend to both rooms. 1/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KIDANGO HUBBARD CENTER
FACILITY NUMBER: 434406756
VISIT DATE: 11/02/2022
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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 have telephone services, heating, lighting, and ventilation.

General sanitization & safety: Preschool children have their own cubby to store their belongings. Per Director, sick children are isolated in the meditation area. LPA observed that all storage containers for solid waste, including moveable trash receptacles have tight-fitting covers that are kept on, and in standard condition, with foot petals to open. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medications and other hazardous items that pose a risk to children, were inaccessible to the children in care. Director states that poisons are kept within the outdoor storage, locked. The keys are with the custodian. No bodies of water or other hazards were observed during inspection. Director understands that smoking is prohibited. Per Director there are no firearms on site.

Kitchenette: Each classroom has a kitchenette area, with access to a microwave, dishwasher and a sink. All kitchen areas/food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. Water and refrigerator temperatures are in standard condition. Director states waste is to be discarded immediately after each meal.

Food: Menus are posted on site one month in advance, in each classroom. Menus for the past one year are available upon request. Facility provides Snacks (AM/PM), breakfast and lunch. LPA reviewed food for availability, quantity and appropriateness to children in care. Per Director, all meals are prepared daily at the head office (Freemont) 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. LPA and director discussed a name, picture and allergy list posted in kitchen area for best practice. Director states there are currently four children with lactose allergies and one with a mango allergy. LPA observed an allergy list posted on each refrigerator. Any food brought from home is labeled. 2/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6
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 HUBBARD CENTER
FACILITY NUMBER: 434406756
VISIT DATE: 11/02/2022
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Lavatories: There are two children's lavatories, across from one another. There are two toilets in each, four in total, one sink in each and two in total. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. Director states that if there is low attendance, a sick child will utilize one of the bathrooms. When there is full attendance, the farthest toilet on either side will be used, closed until cleaned. All hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. Directors states that the staffroom lavatory is in the main office of the school.

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. Per Director this playground is not shared with the school district. There is a sandbox covered with a door and locked when not in use, inspected daily and before use. There is a locked storage in the playground, where custodial supplies are kept. LPA observed outdoor water fountain supply has been cut off, per Director this is permanent. LPA observed a patio area in the playground, which is a slipping hazard when wet. It was raining on this day. Director and LPA discussed covering section with non-slip material. Director and LPA discussed facility placing a mesh fence on the back fence, to cover bottom gaps. LPA did not observe violations in the playground, this is for best practice.

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 10/01/2024. All staff present have the following: MMR & Tdap vaccinations, flu vaccine or the opt out. All staff has completed Mandated Reporter Training, Director’s training valid thru 06/03/2024. Directors understand this must be renewed every two years. LPA/s reviewed 4 children's files and issued an LIC 857. LPA reviewed 4 staff files total. All files were observed to be complete.

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. LPA/s obtained a roster and personnel report at the conclusion of this inspection. 3/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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 HUBBARD CENTER
FACILITY NUMBER: 434406756
VISIT DATE: 11/02/2022
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Waivers: There is one waiver on file for Primary facility file, Kidango Ohlone Chynoweth Center (facility 434404854) as the central administrative file for Criminal Record Association. Facility is currently in compliance with the terms of the waiver.

Medical & First Aid Supplies: There is a first aid kit in each classroom, kept in a backpack. LPA reviewed kit to ensure supplies are complete. Director states that supplies are checked every two months by the program director/s. 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 a locked cabinet and/or in emergency backpack when outside (at least six feet high) which is stored out of reach of children.



Per Director there is currently one child enrolled who requires Incidental Medical Services (IMS). The epi pen is kept in the emergency backpack and is to be kept within a locked box. Director understands any medication that requires cooler temperatures, will be refrigerated, per instructions. Incidental Medical Services (IMS) policy was reviewed. 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 10/23/2022; There is a Fire extinguisher, size 3A40BC in each room, last serviced 10/23/2022; the last fire drill was conducted on 10/04/2022, Director understands this is to be completed every six months.

Napping: Per Director there is currently no napping, as this is a half day program. There is a couch to rest on if needed, bedding is not shared, is brought from home and is kept in their cubicles; stored as not to touch. 4/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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 HUBBARD CENTER
FACILITY NUMBER: 434406756
VISIT DATE: 11/02/2022
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Lead Testing: Director states a certified external water sampler took a test at the end of October. The Director has not received results, LPA observed all drinking fountains are currently capped off. Director understands providers must submit the LIC 9275, a completed signed and dated childcare sampling checklist form LIC9276 and a facility sketch LIC 999 fully labeled with locations of all water outlets to their LPA and self-report testing results. As a safety measure, Director will continue to close off off any indoor drinking fountains.

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. LPA and Director discussed updating relocation site in the event of an emergency, which lists another preschool. Director has filled out LIC 610 and post it at the conclusion of this visit.

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 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. 5/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
Page: 4 of 6
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 HUBBARD CENTER
FACILITY NUMBER: 434406756
VISIT DATE: 11/02/2022
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SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative. 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


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 NO DEFICIENCIES being cited in accordance with Title 22 of the California Code of Regulations and Health & Safety codes. LPA and Director discussed the following: 1. Updating LIC 610. This was complete by the end of inspection/. 2. Director and LPA discussed facility placing a mesh fence on the back outdoor fence, to cover bottom gaps. 3. LPA observed a patio area in the playground, which is a slipping hazard when wet. It was raining on this day. Director and LPA discussed covering section with non-slip material. 4. Name to face allergy list posted. 5. In room 82, there is an exit door that opens easily and leads to a busy parking lot. LPA and Director discussed activating existing lights to alert staff when opened. Director will check with fire department to inquire. Director understands that while facility is currently in compliance, failure to take such measures may result in future citations. Director will send photos via email to LPA, this shall be complete within four weeks and understands LPA may conduct an unannounced case management to inspect the facility for updates.
A notice of site visit was issued and must remain posted for 30 consecutive days. Exit interview conducted and report was reviewed with facility representative. 6/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6