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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414073
Report Date: 10/25/2022
Date Signed: 10/25/2022 03:35:30 PM

Document Has Been Signed on 10/25/2022 03:35 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:KIDANGO EDEN PALMS PRESCHOOLFACILITY NUMBER:
434414073
ADMINISTRATOR:MICHELLE PALACPACFACILITY TYPE:
850
ADDRESS:5398 MONTEREY RDTELEPHONE:
(408) 200-2910
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 31DATE:
10/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Palacpac, MichelleTIME COMPLETED:
03:40 PM
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On this day Licensing Program Analyst/s (LPA/s) Almaraz, Celi conducted an unannounced annual random inspection. Due to COVID- 19 precautionary measures were taken. This facility is currently licensed for a capacity of 45. Licensing staff met with Director Palacpac, Michelle and explained the nature of today’s inspection. This is a Preschool program that currently operates from 7:30AM to 5:30PM, Monday thru Friday. Licensing staff was taken on a guided tour of the facility of both indoors and outdoors. At the initial start of this visit, there was a total census of 31 children and a total census of 5 staff, one Director, two teachers, two assistants were present. This is a double component facility, there is an infant program 434414074 on campus.

Physical Plant: All areas identified on the Facility Sketch were inspected. This preschool program which consists of the following classrooms: Room 134 LPA observed the following: Staff # 1 a fully qualified teacher with one assistant (Staff #2) and 16 preschool children. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to four sinks, three toilets. Room 135 is adjacent to room 134, LPA observed the following: Staff # 3 a fully qualified teacher with one assistant (Staff #3) and 15 preschool children. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to one toilet and one sink.

LPA observed that all items that may pose a threat to children were locked in the kitchenette area. LPA advised Director that for best practice to place safety knobs on door that leads to the kitchenette area, infant toddler room and office. Director will place an order and send the information to LPA. All classrooms observed to have suitable furniture and equipment, which were inspected for age appropriateness. All classrooms observed to have sufficient have telephone services, heating, lighting, and ventilation. There was one child size couch that had a tear, this was removed by Director during inspection. LPA has advised facility have a deep cleaning. 1/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2022
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: KIDANGO EDEN PALMS PRESCHOOL
FACILITY NUMBER: 434414073
VISIT DATE: 10/25/2022
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General sanitization & safety: Children have their own cubby to store their belongings. Per Director, sick children are isolated in the director's office. LPA advised Director that all storage containers for solid waste, including moveable trash receptacles must have tight-fitting covers that are kept on, and in standard condition and for best practice foot petals to open. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other hazardous items that pose a risk to children, were inaccessible to the children in care. Director states that poisons are kept with the custodian. No bodies of water or other hazards were observed during inspection. Director understands that smoking is prohibited. Per Director there are no firearms on site.

Kitchen: All kitchen areas/food preparation and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. Water and refrigerator temperatures in standard condition. Director states waste is to be discarded immediately after each meal. LPA has advised for best practice kitchen have a deep cleaning and organization.

Food: Menus are posted on site one month in advance, in each classroom. Menus for the past one year are available upon request. Facility provides Snacks (PM), breakfast and lunch. LPA reviewed food for availability, quantity and appropriateness to children in care. Per Director, all meals are prepared daily at the head office (Freemont) and transported to facility. Snacks and supplemental food with 5 components kept on site. Per Director there is an allergy list for each child posted in kitchen area. LPA and director discussed a name, picture and allergy list posted in kitchen area for best practice. Director states there is currently one child with a lactose allergy.

Lavatories: All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the office is used as an isolation area for a sick child in care. Directors states that the staffroom lavatory is shared with the main office of the apartment complex where this campus is located. There is a lavatory to utilize for a sick child in care in class room 135, Director states other children would then use the lavatories in room 134 in this case. 2/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: KIDANGO EDEN PALMS PRESCHOOL
FACILITY NUMBER: 434414073
VISIT DATE: 10/25/2022
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Outdoor Playground: Equipment is in safe condition, free of sharp, defective or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed. This facility is in Eden Palms apartment complex, main building is shared with leasing office. There is a sandbox covered with a tarp when not in use, inspected daily before use. There is a locked storage in the playground, where custodial supplies are kept. LPA and Director discussed for best practice replacing synthetic grass in the back area where is has been damaged, filling in crevices and replacing a safety light attached to the exit door.

Facility Records: LPA/s issued Review of Staff records (LIC 859) to the Director during this inspection. At least one staff (Director) has record of CPR and First Aid, valid until 08/13/2024. All staff present have the following: MMR & Tdap vaccinations, flu vaccine or the opt out. All staff has completed Mandated Reporter Training, Directors training valid thru 01/12/2024. Directors understand this must be renewed every two years. LPA/s reviewed 4 children's files and issued an LIC 857. LPA reviewed 4 staff files total. All files were observed to be complete.

Sign in and out: Procedures were reviewed by LPA/s to ensure that children who are present where sign in. Facility uses an electronic sign in/sign out system. LPAs obtained a roster and personnel report at the conclusion of this inspection.

Waivers: There is one waiver on file for Primary facility file, Kidango Ohlone Chynoweth Center (facility 434404854) as the central administrative file for Criminal Record Association. Facility is currently in compliance with the terms of the waiver.

Medical & First Aid Supplies: There is a first aid kit in each classroom, kept in a backpack. LPA reviewed kit to ensure supplies are complete. Director states that supplies are checked every month. Per Director medication is only administered to a child when accompanied with a doctor's note, parent plan, authorizations are to be completed monthly. The medication is kept in a locked cabinet and/or in emergency backpack when outside ( at least six feet high) which is stored out of reach of children. 3/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: KIDANGO EDEN PALMS PRESCHOOL
FACILITY NUMBER: 434414073
VISIT DATE: 10/25/2022
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Per Director there are currently no children enrolled who required Incidental Medical Services (IMS). Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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

Fire & Safety: Carbon monoxide detectors and smoke detectors are working and present in the facility, the fire department conducted a fire inspection on 11/2021. There are Fire extinguishers, size 3A40BC in each room, last serviced 11/2021 (there is no day of the month indicated); a last fire drill was conducted on 10/17/2022 Director understands this is to be completed every six months.

Matts and cots: Cots inspected for napping were observed to be maintained in a safe condition with no exposed foam. Constructed of material at least 3/4 inch thick. Covered with vinyl or similar material that can be wiped. Designed so that the sleeping side can be distinguished from the floor side. Per Director cots are wiped weekly with a detergent, disinfectant or when soiled or wet. Each cot observed to be equipped with a sheet and/or blanket to cover the child. Per Director bedding is not shared and is washed on site each Friday (or when soiled) to be laundered. LPA reminded Director that bedding shall be individually stored so that each child's bedding is identifiable, and no child's used bedding shall meet other bedding. Bedding is stored on top of each cot, so as not to touch.



Lead Testing: Director states a certified external water sampler attempted to take a sample on 10/20/2022 and was unable to test due to water leaking in bag. Director stated this will be rescheduled in the next two weeks. Director understands providers must submit the LIC 9275, a completed signed and dated childcare sampling checklist form LIC9276 and a facility sketch LIC 999 fully labeled with locations of all water outlets to their LPA and self report testing results. As a safety measure, Director has currently capped off any facets . 4/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 6 of 6
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: KIDANGO EDEN PALMS PRESCHOOL
FACILITY NUMBER: 434414073
VISIT DATE: 10/25/2022
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LPA advised Director to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. For commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Postings: Parent’s Rights Poster (with complaint Hotline) was observed during this inspection. LPA observed all required postings, including license and emergency disaster plan. LPA and Director discussed updating relocation site off premises in the event of an emergency, Director will fill out form and post on or by the end of this work week.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process

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.

SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers 5/6

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 5 of 6
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: KIDANGO EDEN PALMS PRESCHOOL
FACILITY NUMBER: 434414073
VISIT DATE: 10/25/2022
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The following was discussed:
· Reporting Requirements.
· The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations.
· All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties.

All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions.

LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

There are no deficiencies being cited in accordance to Title 22 of the California Code of Regulations and Health & Safety codes.

LPA and Director discussed the following: 1. Deep cleaning for the facility, show proof of completion. 2. Trash bins replaced throughout facility to include foot petals and tighter fitting lids. 3. Deep cleaning and organization of kitchen. 4. Food to be placed in plastic bins or a similar system. 5. A name to face list of allergies posted. 6. Synthetic grass repaired. 7. A working light bulb placed in the emergency exit. 8. Crevices repaired in the playground. 9. Safety knobs on adjacent doors. 10. Updated LIC 610, relocation sites. Director understands that while facility is currently in compliance, failure to take such measures may result in future citations. Director will send photos via email to LPA, this shall be complete within four weeks and understands LPA may conduct an unannounced case management to inspect the facility for updates.

A notice of site visit was issued and must remain posted for 30 consecutive days.

Exit interview conducted and report was reviewed with facility representative. 6/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
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