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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406759
Report Date: 05/17/2023
Date Signed: 05/17/2023 12:44:57 PM

Document Has Been Signed on 05/17/2023 12:44 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 LINDA VISTAFACILITY NUMBER:
434406759
ADMINISTRATOR:NDON TERSIFACILITY TYPE:
850
ADDRESS:65 GORDON AVENUETELEPHONE:
(408) 353-0677
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 21DATE:
05/17/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Tersie Ndon TIME COMPLETED:
01:02 PM
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 Licensing Program Analyst (LPA) Pete Hernandez, met with Director, Terise Ndon, for a subsequent case management visit in regards to the lead testing results submitted by the facility and explained the reason for the visit to them. Present were 1 staff with 21 children in care during nap time.

Facility submitted that there was an exceedance of about 600 (ppb) sample (D) room 84 from the bathroom sink faucet. LPA verified that this has been repaired and passed the lead testing. The facility is now able to use the water from the repaired faucet and has passed lead safety testing of 5.5 (ppb) or less. Copies of the retesting documentation have been reviewed and copies retained.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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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