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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415820
Report Date: 02/06/2024
Date Signed: 02/06/2024 11:09:26 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/03/2023 and conducted by Evaluator Janette Cruz
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20231103140418
FACILITY NAME:KIDDIE ACADEMY OF ALMADEN VALLEYFACILITY NUMBER:
434415820
ADMINISTRATOR:OLIVIA LOPEZFACILITY TYPE:
850
ADDRESS:16607 ALMADEN EXPRESSWAYTELEPHONE:
(408) 752-4803
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:142CENSUS: DATE:
02/06/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Rick Kowalczyk and Sarah LaubTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff caused injury to day care child.
Staff handles day care children in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janette Cruz conducted an unannounced follow up complaint investigation and met with Rick Kowalczyk, Licensee and Sarah Laub , interim Director. Purpose of today's investigation: deliver investigation findings.

The investigation was conducted by Investigator Megan Mullen. Based on interviews, observations, record reviews, and evidence gathered during the investigation process, the Department concludes that facility staff/teacher handled children in a rough manner and staff/teacher caused an arm injury to a day care child. The above allegations are thus found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

A "Type A" deficiency is being cited on the attached LIC 9099-D. Exit interview conducted and report was reviewed with Rick Kowalczyk, Licensee and Sarah Laub, interim Director. Appeal rights were also provided to Rick and Sarah prior to conclusion of today's inspection. Notice of site visit was issued and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 07-CC-20231103140418
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: KIDDIE ACADEMY OF ALMADEN VALLEY
FACILITY NUMBER: 434415820
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/07/2024
Section Cited
CCR
101223(a)(3)
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101223 Personal (a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement was not met as evidenced by:
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Licensee states that staff/teacher shall be required to attend a positive discipline class and a class agenda with proof of attendance will be submitted to Licensing. Licensee will also submit to LPA a written plan of action indicating understanding children's personal rights.
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Based on observation, interviews and record reviews, Licensee did not comply with section cited above, A facility staff/teacher handled children in a rough manner and staff/teacher caused an arm injury to a day care child which posed an immediate health, safety or personal rights risk to persons in care.
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Licensee must provide copies of this report to parents/guardians of children in care at this facility and to parents/guardians of children newly enrolled at this facility during the next 12 months per the AB633 requirements.

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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: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Janette CruzTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
LIC9099 (FAS) - (06/04)
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