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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415211
Report Date: 03/21/2024
Date Signed: 03/21/2024 03:31:14 PM


Document Has Been Signed on 03/21/2024 03:31 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:KIDANGO ARBUCKLEFACILITY NUMBER:
434415211
ADMINISTRATOR:VANESSA PAIZFACILITY TYPE:
830
ADDRESS:1910 CINDERELLA LN, RM 165&166TELEPHONE:
(408) 905-8985
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY:32CENSUS: 26DATE:
03/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Vanessa PaizTIME COMPLETED:
03:45 PM
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On 3/21/24 at 2:00pm Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced Case Management inspection at the facility but the director was out for a meeting and had the lead teacher, May Cortez, to take over the director’s responsibilities. Around 2:30 the director came back to the facility. LPA explained the purpose of the inspection to the director.

On 3/13/24 and 3/15/24 the licensing department received two incident reports from the facility. One incident allegedly involved with S1’s inappropriate handling of supervision and the other was related to a parent’s concerns about C1. LPA conducted interviews with the director and staff. The staff related to the incidents was not in the facility.

During the inspections, no results had been made. The director stated that human resources would conduct further investigations on the allegedly inappropriate handling of supervision and that the facility will continue working with the parent to clarify the concerns.

No regulatory violations were observed during the inspection.

Exit interview was conducted and report was reviewed with Vanessa Paiz. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Sheena ChinTELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2024
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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