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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417051
Report Date: 07/06/2023
Date Signed: 07/06/2023 02:56:35 PM

Document Has Been Signed on 07/06/2023 02:56 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:KINDERWOOD PRESCHOOLFACILITY NUMBER:
434417051
ADMINISTRATOR:CHEYENNE BOHNFACILITY TYPE:
850
ADDRESS:5560 ENTRADA CEDROSTELEPHONE:
(408) 839-5669
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 69TOTAL ENROLLED CHILDREN: 72CENSUS: 60DATE:
07/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cheyenne BohnTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Janette Cruz met with Cheyenne Bohn, Director, for an unannounced Plan of Correction (POC) inspection. Purpose of today’s inspection: verify completion of the Plans of Correction resulting from case management inspection completed on 06/29/23. LPA toured indoor and outdoor areas of the facility.

The facility was issued a Type A deficiency on 06/29/23:
1. Section 101170(e)(1) Criminal Record Clearance - wherein a staff (S1) who floats to supervise in both preschool and infant program (434417052) classrooms, staff S1, did not have criminal record clearance on file.

The Licensee, Gireesh Malhotra, submitted a written Plan of Correction to LPA Cruz in which Licensee indicates understanding of Title 22 Section 101170(e)(1) regulation. LPA observed that S1 is no longer present in the facility during today's inspection.

LPA observed signed LIC9224 Acknowledgement of Receipt of Licensing Report in the children's files.

LPA concludes that Licensee have completed the required Plan of Correction. No other deficiencies issued during today's inspection.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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