434408795-9-23-2022-07-CC-SYIP-CJJTAT-20220923143404

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408795
Report Date: 09/21/2022
Date Signed: 09/23/2022 02:34:16 PM

Document Has Been Signed on 09/23/2022 02:34 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:	KIDDIE ACADEMY OF MORGAN HILL		FACILITY NUMBER:	434408795
ADMINISTRATOR:	NAKIA CENTENO		FACILITY TYPE:	850
ADDRESS:	15750 MONTEREY ROAD, SUITE 150		TELEPHONE:	(408) 776-6800
CITY:	MORGAN HILL	STATE: CA	ZIP CODE:	95037
CAPACITY: 84	TOTAL ENROLLED CHILDREN: 84	CENSUS: 31	DATE:	09/21/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Nakia Centeno		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required-1 Year inspection. LPA met with Director Nakia Centeno and explained the reason for the inspection. Present during today's inspection were 31 children and 6 staff. Facility was within ratio during today's inspection. There is an area to post required postings, such as license and parent's rights. The hours of operation are Monday through Friday 7AM to 6PM. There is a working phone at the facility. LPA toured the inside and outside of the facility. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible. There are toys and equipment for the children. LPA discussed with Director about checking furniture, such as shelves for an damage, and washing carpets/rugs for children. There a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The outdoor area is fenced. Area around play structure have resilient material. Shaded rest area is provided through trees, canopy, and building overhang. Facility has a waiver to for the school-age program and the preschool program to share space. Facility provides meals and snacks to the children. Menu was observed to be posted. Drinking water is provided through individual water bottles, water pitcher and cups, and water fountain. ----------------continues on 809 dated 09/21/2022 page 2------------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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: KIDDIE ACADEMY OF MORGAN HILL	FACILITY NUMBER: 434408795
	VISIT DATE: 09/21/2022

NARRATIVE

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---------------continuation of 809 dated 09/21/2022 page 1--------------------
Facility does provide Incidental Medical Services. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. Director will obtain physician's order for C-4 and send it to Licensing. For IMS information, see PIN 22-02-CCP. A 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

Six (6) children's files were reviewed during today's inspection. The records reviewed include but not limited to Physician's Report and Screening to Risk of TB. C-1 and C-2 did have Screening for TB Risk Factor checked off. C-3 did not have Physician's Report on file. LPA discussed with Director about ensuring that they are obtaining updated immunization records. Director emailed a copy of facility to Licensing.

Four (4) staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit, immunization records, and Mandated Reporter training. There is a least one staff with a valid CPR/1st Aid, which expires on 03/18/2024. LPA reminded Director to ensure all forms are filled out and signed, such as LIC 9108 and LIC 508.

All adults present have cleared fingerprints. 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.

---------------continues on 809 dated page 09/21/2022 page 3----------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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: KIDDIE ACADEMY OF MORGAN HILL	FACILITY NUMBER: 434408795
	VISIT DATE: 09/21/2022

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-----------------continuation of 809 dated 09/21/2022 page 2--------------------

Facility will submit the following:
- Screening for TB Risk Factor for C-1 and C-2
- C-3's Physician's Report
- C-4's physician's order for medication
- S-1's Health Screening
- S-2's Child Care Provider Mandated Reporter training certificate

As a result of this inspection, one type B citation was issued. Exit interview conducted and report was reviewed with Director Nakia Centeno. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/23/2022 02:34 PM - It Cannot Be Edited

Created By: Samantha Yip On 09/21/2022 at 01:26 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 MORGAN HILL	FACILITY NUMBER: 434408795
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/21/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(b)(2)

Child's Medical Assessments

(b) The medical assessment shall provide the following: (2) Results of a test for tuberculosis. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 3 out of 6 persons, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/21/2022
	Plan of Correction
1 2 3 4	By POC 10/21/2022, Director will send proof that screening for TB risk factor is completed on physician's report.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Joel Segura

LICENSING EVALUATOR NAME:

Samantha Yip

LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC809 (FAS) - (06/04)

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