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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434412171
Report Date: 07/07/2026
Date Signed: 07/07/2026 03:12:10 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/29/2026 and conducted by Evaluator Marilou Monico
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20260629153724
FACILITY NAME:KIDDIE ACADEMY OF CUPERTINOFACILITY NUMBER:
434412171
ADMINISTRATOR:JACALNE, MARIA SOCORROFACILITY TYPE:
850
ADDRESS:19875 STEVENS CREEK BLVD.TELEPHONE:
(408) 517-0454
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:119CENSUS: 84DATE:
07/07/2026
UNANNOUNCEDTIME BEGAN:
11:54 AM
MET WITH:Maria Socorro JacalneTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff do not ensure sinks are maintained in good repair.
INVESTIGATION FINDINGS:
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On July 7, 2026, Licensing Program Analyst (LPA), Marilou Monico, made an unannounced complaint investigation. LPA met with Site Director, Maria Socorro Jacalne, and discussed the allegation. LPA conducted a facility tour and completed a census. Staff were interviewed, and pertinent documents were collected.

Based on LPA's observations and interviews, it was determined that the sink in Room 4 has not been operational for approximately one month. LPA observed that the sink was covered with a tray, and a plant pot had been placed on top of the tray. The preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED.

Exit interview conducted and report was reviewed with Site Director, Maria Socorro Jacalne. Appeal rights were provided.

Continuation on next pages:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Adam Hamer
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 07-CC-20260629153724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CUPERTINO
FACILITY NUMBER: 434412171
VISIT DATE: 07/07/2026
NARRATIVE
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Per Title 22, Division 12, of the California Code of Regulations, the following Type B deficiency is being cited: (see next page).

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISORS NAME: Adam Hamer
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 07-CC-20260629153724
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CUPERTINO
FACILITY NUMBER: 434412171
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/20/2026
Section Cited
CCR
101238(a)
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Buildings and Grounds - (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
This requirement is not met as evidenced by:
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The Site Director stated that the sink will be repaired, and agreed to submit a written plan along with proof of repair by 07/20/26.
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Based on the LPA's observations and staff interviews, the sink in Room 4 has been inoperable for approximately one month. This poses a potential risk to the health, safety, and personal rights to 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: Adam Hamer
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4