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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408795
Report Date: 06/30/2023
Date Signed: 06/30/2023 11:23:32 AM

Document Has Been Signed on 06/30/2023 11:23 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KIDDIE ACADEMY OF MORGAN HILLFACILITY NUMBER:
434408795
ADMINISTRATOR:NAKIA CENTENOFACILITY TYPE:
850
ADDRESS:15750 MONTEREY ROAD, SUITE 150TELEPHONE:
(408) 776-6800
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 84TOTAL ENROLLED CHILDREN: 60CENSUS: 32DATE:
06/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:Bertha FariasTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Other inspection. LPA met with Assistant Director Bertha Farias and explained the reason for the inspection. The purpose of this inspection is LPA observed that S-1 was present at the facility, but is not associated to the facility roster.

S-1's has cleared criminal record and child abuse index. S-1 was disassociated by the center on 04/28/2021. S-1 is not associated to any of the other licenses on site. Facility will transfer fingerprints either by sending in the LIC 9182 to the San Jose Regional Office or by transferring fingerprints through Guardian. Assistant Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

As a result of this inspection, a Type A citation was issued. A civil penalty of $500 was assessed for Caregiver Background Check. Exit interview conducted and report was reviewed with Assistant Director Bertha Farias. A notice of site visit was given and must remain posted for 30 days.

LPA Samantha Yip informed Assistant Director that this report dated 06/30/2023 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Samantha informed the Assistant Director, Bertha Farias, to provide a copy of this licensing report dated 06/30/2023 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2023
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 06/30/2023 11:23 AM - It Cannot Be Edited


Created By: Samantha Yip On 06/30/2023 at 10:57 AM
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: 06/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/01/2023
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 101170(f)...
This requirement is not met as evidenced by:
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By 07/01/2023, facility will transfer S-1's fingerprints to facility.
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Based on record review, S-1 was disassociated on 04/28/2021, which poses an immediate health and safety risk to children in care.
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A civil penalty of $500 is assessed for caregiver background check.

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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:Joel Segura
LICENSING EVALUATOR NAME:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2023


LIC809 (FAS) - (06/04)
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