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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414074
Report Date: 12/07/2022
Date Signed: 12/07/2022 03:53:18 PM


Document Has Been Signed on 12/07/2022 03:53 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 INFANTFACILITY NUMBER:
434414074
ADMINISTRATOR:MICHELLE PALACPACFACILITY TYPE:
830
ADDRESS:5398 MONTEREY RDTELEPHONE:
(408) 200-2910
CITY:SAN JOSESTATE: CAZIP CODE:
95111
CAPACITY:9CENSUS: 5DATE:
12/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Palacpac, MichelleTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Almaraz, conducted an unannounced case management inspection to follow up on a previous visit dated 10/27/2022. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with the Director Palacpac, Michelle and explained the nature of today's inspection. Teacher child ratios observed, personal rights observed and staff names recorded.

During previous inspection dated 10/27/2022, LPA cited for the following: 1. 101226 (C) A refrigerator shall be used to store any medication that requires refrigeration. Director was to place a refrigerator in the infant center, which did not have one. 2. 101439(h)(1) Infant changing tables shall: (1) Have a padded surface no less than one-inch thick and be covered with washable vinyl or plastic. LPA observed a refrigerator has been placed in the infant room and the infant table has a padded surface no less than one inch think. These citations have been cleared during this inspection and a POC letter has been issued to Director.

During previous inspection dated 10/27/2022, LPA also advised in previous visit the following: 1. Deep cleaning and organization for the facility. 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. LPA observed the facility has been cleaned, trash bins have been replaced with foot petal trash bins, the kitchen appears to have been cleaned, food has been placed in storage bins, name to to face list of allergies has been posted.

There are no deficiencies issued in accordance with Chapter 1, Division 12, Title 22 of the California Code of Regulations. An exit interview conducted, and report was reviewed with licensee.

NOTICE OF SITE VISIT ISSUED AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022
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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