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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408782
Report Date: 07/02/2024
Date Signed: 07/02/2024 10:41:02 AM

Document Has Been Signed on 07/02/2024 10:41 AM - 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:KIDDIE ACADEMY OF SAN JOSEFACILITY NUMBER:
434408782
ADMINISTRATOR/
DIRECTOR:		MARIE NUNEZFACILITY TYPE:
840
ADDRESS:521 WEST CAPITOL EXPRESSWAYTELEPHONE:
(408) 978-1500
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 21TOTAL ENROLLED CHILDREN: 26CENSUS: 11DATE:
07/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:23 AM
MET WITH:Marie NunezTIME VISIT/
INSPECTION COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Mandeep Kaur conducted an Case Management-Incident inspection, that was self-reported to the department on June 24, 2024 and occurred on June 21, 2024. LPA met with Director, Marie Nunez and explained the reason of the inspection.

LPA toured the inside of the facility: Room Exploring My World (Jr Preschool-2) and restroom area with Director.

LPA reviewed one staff (S1) file, one child (C1) file and obtained the contact information for staff (S2 & S3).

LPA interviewed one staff(S1) and Director. Director stated that incident happened under preschool component and copy of the Unusual Incident report was obtained under preschool component.

No further investigation needed under school age component. No deficiency issued during todays inspection.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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