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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406756
Report Date: 03/27/2025
Date Signed: 03/27/2025 03:27:23 PM

Document Has Been Signed on 03/27/2025 03:27 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KIDANGO HUBBARD CENTERFACILITY NUMBER:
434406756
ADMINISTRATOR/
DIRECTOR:		JACKELIN SOLORIOFACILITY TYPE:
850
ADDRESS:1680 FOLEY AVENUETELEPHONE:
(408) 353-0559
CITY:SAN JOSESTATE: CAZIP CODE:
95122
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 24DATE:
03/27/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Jackelin SolorioTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Anna Morales conducted a Case Management visit to further investigate two seperate Unusual incidents that were self reported by the facility to Licensing on 3/10/25 and on 3/24/25. LPA met with Site Director Jackelin Solorio. Director stated that both incidents occurred with the 82 classroom(full day session).

LPA notes that there are two preschool classrooms, Classroom 83 and Classroom 82. Classroom 83 operates in two sessions:
83am(7:15am-11:15am)and 83pm(11:45am-3:15pm). In Classroom 83am, LPA observed 8 children and two staff in the am session.

Classroom 82 operates in Full day session: 7:30am-5:30pm. LPA observed 16 children and three staff.

LPA conducted interviews with Regional Director Connie Byrd, Site Director and two staff.
Director stated on 3/7/25, an incident occurred in Classroom 82(full day session) at approximately at 11am. Director stated that there were 21 children and three staff present. She stated that one of the Staff(S1)informed her that she/he observed another Staff(S2)inappropriately holding one of the children's(C1) both forearms while taking the child(C1)to a seat. Director stated that there were no injuries observed on the child and there were other staff present(two staff). Director stated that the incident was further investigated, and based on their investigation, Staff(S1) services was terminated. LPA interviewed two other Staff(S3)(S4) who stated that they did not observe the incident. LPA was informed that S2 was not present.
Continue on LIC809c.....
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Anna Morales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: KIDANGO HUBBARD CENTER
FACILITY NUMBER: 434406756
VISIT DATE: 03/27/2025
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Director stated that the Incident that occurred on 3/20/25, occurred outside in the center's playground approximately at 11am-11:30am, and there were 20 children and three staff present. Director stated that the Regional Director, Connie Byrd observed the incident and would be available for interview. LPA conducted an interview with Connie who stated that on 3/20/25, she observed Staff(S2)pull Child(C2)upper left arm behind C2's body, and remove a toy out of Child's(C2)right hand.
Regional Director and Site director stated that there were other well trained staff present and the child(ren) were not left alone with S2.
Both Director's stated that Staff(S2) has been placed on Administrative Leave, and has not returned to the facility at this time.

Based on available evidence and interviews, it was determined that on 3/20/25, Staff(S2)inappropriately pulled Child(C2)upper Left arm behind Child(C2's) body, and removed a toy out of Child(C2's)right hand. This warrants a TYPE B- citation on follows on LIC809D. Exit interview was conducted with Site Director and discussed the PLAN OF CORRECTION(POC).
Appeal Rights were given.

NOTICE OF SITE VISIT WAS ISSUED AND INFORMED DIRECTOR TO POST IN A VISIBLE LOCATION FOR THIRTY DAYS.
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Anna Morales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/27/2025 03:27 PM - It Cannot Be Edited


Created By: Anna Morales On 03/27/2025 at 12:34 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KIDANGO HUBBARD CENTER
FACILITY NUMBER: 434406756

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/03/2025
Section Cited
CCR
101223(a)(2)

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(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director will submit a plan to ensure that the children's Personal Rights are not violated by the POC(plan of correction) date, 4/3/25.
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Based on interviews conducted,Staff(S2)pulled Child(C2)upper left arm behind Child(C2's) body, and removed a toy from the Child's(C2)right hand, which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Gladys Kuizon
NAME OF LICENSING PROGRAM MANAGER:
Anna Morales
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2025


LIC809 (FAS) - (06/04)
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