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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408781
Report Date: 11/09/2023
Date Signed: 11/13/2023 02:31:01 PM

Document Has Been Signed on 11/13/2023 02:31 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:KIDDIE ACADEMY OF SAN JOSEFACILITY NUMBER:
434408781
ADMINISTRATOR:MARIE NUNEZFACILITY TYPE:
850
ADDRESS:521 WEST CAPITOL EXPRESSWAYTELEPHONE:
(408) 978-1500
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 98TOTAL ENROLLED CHILDREN: 46CENSUS: 35DATE:
11/09/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Ravinder GaudTIME COMPLETED:
02:35 PM
NARRATIVE
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Licensing Program Analyst (LPA), Farida Raja, conducted an unannounced case management inspection. LPA met with Owner, Ravinder Gaud and explained the nature of today's inspection. LPA conducted a facility walk through and observed a total of 35 children and 3 teachers within the classrooms toured at the facility. Children were napping during today's inspection.

In an unannounced visit conducted on 10/27/2023, LPA observed that Director failed to report four confirmed cases of head lice at the facility.

One (1) Type B deficiency is being cited on the attached LIC 809D page. Appeal rights were printed and provided to owner.

Exit interview was conducted with owner, Ravinder Gaud.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Farida Raja
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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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Document Has Been Signed on 11/13/2023 02:31 PM - It Cannot Be Edited


Created By: Farida Raja On 11/09/2023 at 02:02 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: KIDDIE ACADEMY OF SAN JOSE
FACILITY NUMBER: 434408781

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/23/2023
Section Cited
CCR
101212(d)(1)(E)

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101212 Reporting Requirements(d)Upon the occurrence, ... of any of the events...a report shall be made to the Department by telephone or fax within the Department's next working day ...In addition, a written report...shall be submitted to the Department ...of such event. (1) (E)Epidemic outbreaks.
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Director will submit letter stating review and understanding of licensing regulations by plan of correction of 11/23/2023.
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This requirement is not met as evidenced by: Director did not report four confirmed cases of head lice to Childcare Licensing. This poses a potential risk to the health, safety, and personal rights of children 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.
SUPERVISOR'S NAME:Gladys Kuizon
LICENSING EVALUATOR NAME:Farida Raja
LICENSING EVALUATOR SIGNATURE:
DATE: 11/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/09/2023


LIC809 (FAS) - (06/04)
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