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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414074
Report Date: 10/27/2022
Date Signed: 10/28/2022 04:41:52 PM

Document Has Been Signed on 10/28/2022 04:41 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: 9TOTAL ENROLLED CHILDREN: 9CENSUS: 5DATE:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Palacpac, MichelleTIME COMPLETED:
04:30 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 9. Licensing staff met with Director Palacpac, Michelle and explained the nature of today’s inspection. This is an infant program that currently operates from 7:30 AM thru 5:30 PM, 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 5 children, 2 infant’s and 3 toddlers were present and a total census of 4 staff, one Director, two teachers and one assistant substitute were present. This is a double component facility, there is an preschool program 434414073 on campus. There are currently 8 children enrolled, 18 to 36 months. Per Director there are no children under 18 months accepted to program.

Physical Plant: All areas identified on the Facility Sketch were inspected. This infant program which consists of the following classrooms: Early Head Starts Room. LPA observed the following: Staff # 1,2, two fully qualified teachers with one assistant/s (Staff 3) and 5 children. Teacher child ratios were observed, and staff names recorded. Personal rights observed. There is access to two sinks, children in this room are not potty trained. There is currently no potty training being done with the children enrolled, This is adjacent to the preschool program, which has access to toilets if needed, this is separated by a door. 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. LPA has advised facility to have a deep cleaning.

General sanitization & safety: Infants and toddlers 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. 1/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 INFANT
FACILITY NUMBER: 434414074
VISIT DATE: 10/27/2022
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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. LPA observed that the refrigerator is utilized for staff and children.

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.

Lavatories or change tables: 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. Director 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 care. All change tables and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. Bottles are labeled and kept in staff and preschool fridge. LPA has advised that children need their own fridge due to spacing. According to Title 22, division 12 of The California Code of regulations, regulation 101429, 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 the surface is not padded. 2/6

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

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
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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 INFANT
FACILITY NUMBER: 434414074
VISIT DATE: 10/27/2022
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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. LPA discussed for best practice for a cleaning of the outdoor area.

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 1 children's files and issued an LIC 857. LPA reviewed 2 staff files total. All files were observed to be complete. Substitute has an electronic file, is fingerprint cleared.

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: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
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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 INFANT
FACILITY NUMBER: 434414074
VISIT DATE: 10/27/2022
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Safe sleep: LPA/s observed and inspected sleeping equipment for infants. LPA/s observed there are no cribs, discussed that cribs for each infant must be so that they are unable to climb out of the play yard. Equipment must meets the US Consumer Product Safety Commission safety standards. Please see www.safekid.org for a list of any recalled products. Cribs must be free from loose articles and objects. Must have no objects hanging above or attached to the side of the cribs. Play yards must not hinder the entrance or exit to and from the space they are sleeping in. Mattresses must be firm and covered with a fitted sheet that is appropriate to the mattress size. Each infant must have their individual bedding and washed daily or as required. Bedding to be replaced when wet or soiled and is placed in an area inaccessible to infants. Pacifiers must not be attached to anything. Licensee was advised that infants shall not be swaddled while in care and all infants up to 12 months should be placed on their back for sleeping. LIC 9227 (Individual Sleeping Plan) for infants up to 12 months was reviewed. Title 22 Regulation Section 102425(j) Infant Safe Sleep was discussed with the Licensee, including but not limited to documentation that shall be maintained. A review of PIN 20-24-CCP Recently approved Safe Sleep Regulations in Effect was discuss and a copy was provided to the Licensee during this inspection. LPA reminded Director that staff shall physically check on and document the following: 1. Breathing, Sleep position, signs of distress; specified in Responsibility for Providing care and supervision for infants 101429 of Title 22 for more information. Per Director facility does not care for children under 18 months. LPA discussed adding toddler component to license.

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. LPA advised to go to www.ccld.ca.gov lead section to report findings.

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 4/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
LIC809 (FAS) - (06/04)
Page: 9 of 13
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 INFANT
FACILITY NUMBER: 434414074
VISIT DATE: 10/27/2022
NARRATIVE
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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



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. 5/6
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
LIC809 (FAS) - (06/04)
Page: 10 of 13
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 INFANT
FACILITY NUMBER: 434414074
VISIT DATE: 10/27/2022
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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 3 type B 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. Safety knobs on adjacent doors. 7. Updated LIC 610, relocation sites. 8. Carpet cleaning and organization of room. 9. Change table must have padding. 10. This program must have their own refrigerator. Director understands that while facility is currently in compliance with 1 thru 8, 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: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/28/2022 04:42 PM - It Cannot Be Edited


Created By: Araceli Almaraz On 10/27/2022 at 03:18 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: KIDANGO EDEN PALMS INFANT
FACILITY NUMBER: 434414074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(1)(C)
Health-Related Services
(1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (C) A refrigerator shall be used to store any medication that requires refrigeration.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, this component does not have a refrigerator to store a child that needs medication, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/17/2022
Plan of Correction
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2
3
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Licensee shall put a refrigerator in facility for this component only. Must submit proof to LPA.
Type B
Section Cited
CCR
101439(h)(1)
Infant Care Center Fixtures, Furniture, Equipment and Supplies
(h) Infant changing tables shall: (1) Have a padded surface no less than one-inch thick and be covered with washable vinyl or plastic.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above, there is no padded surface to change children, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/17/2022
Plan of Correction
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Licensee shall shall put a padded surface on change table. Must submit proof to LPA.
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:Diana Stephenson
LICENSING EVALUATOR NAME:Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022


LIC809 (FAS) - (06/04)
Page: 12 of 13
Document Has Been Signed on 10/28/2022 04:42 PM - It Cannot Be Edited


Created By: Araceli Almaraz On 10/27/2022 at 03:22 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: KIDANGO EDEN PALMS INFANT
FACILITY NUMBER: 434414074

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Deficiency Dismissed
Type B
Section Cited
CCR
101161(a)


This requirement is not met as evidenced by:A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

Deficient Practice Statement
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2
3
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Based on observation, interviews and record review, the licensee did not comply with the section cited above, the program enrolls children from 18 months to 36 months old, the license is approved for 0 months to 24 months, which poses/posed a potential health, safety or personal rights risk to children in care.
POC Due Date: 11/17/2022
Plan of Correction
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2
3
4
Licensee/Director will submit a request for a toddler option license including the following: 1. LIC 200. 2. Updated handbook. 3. Updated Admission Agreement. 4. Updated needs and services plan. 5. Proof of written permission for all children to attend school within the scope of this age group and license.
Section Cited
Deficient Practice Statement
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2
3
4
N/A
POC Due Date: 11/17/2022
Plan of Correction
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4
N/A
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:Diana Stephenson
LICENSING EVALUATOR NAME:Araceli Almaraz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022


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