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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417051
Report Date: 05/06/2024
Date Signed: 05/06/2024 01:34:46 PM

Document Has Been Signed on 05/06/2024 01:34 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:KINDERWOOD PRESCHOOLFACILITY NUMBER:
434417051
ADMINISTRATOR/
DIRECTOR:		CHEYENNE BOHNFACILITY TYPE:
850
ADDRESS:5560 ENTRADA CEDROSTELEPHONE:
(408) 839-5669
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 69TOTAL ENROLLED CHILDREN: 69CENSUS: 60DATE:
05/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:teacher, Valerie CasteloTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 5/6/24 around 12:45pm Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced Case Management inspection at the facility. The director was off. LPA met with teacher Valerie Castelo. LPA explained that the purpose of today’s visit was to correctly record the inspection on 4/9/24 in system.

On 4/9/24 LPA observed that one staff, S1 did not have the current mandated reporter training certificate. On 4/11/24 this deficiency had been cleared and the clearance letter was sent to the facility via email.

LPA had a tour of classrooms during nap time and observed 18 children with one teacher in room 3, 20 children with one teacher in room 4 and 22 children with on teacher in room 5.

No regulatory violations were observed during the inspection.

Exit interview was conducted and report was reviewed with teacher,Valerie Castelo. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2024
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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Document Has Been Signed on 05/06/2024 01:34 PM - It Cannot Be Edited


Created By: Sheena Chin On 05/06/2024 at 01:19 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: KINDERWOOD PRESCHOOL
FACILITY NUMBER: 434417051

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/16/2024
Section Cited
HSC
1596.8662(b)(1)

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(1) On or before March 30, 2018,... a licensed child day care provider, administrator, or employee of a licensed child day care facility ... shall complete renewal mandated reporter training every two years ...
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The director will send LPA the copy of the mandated reporter training certificate for S1.
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Based on record review, the licensee did not comply with the above regulation. One teacher S1 didn't have have current mandated reporter training certificate on file, which poses an potential Health [and/or], Safety [and/or], Personal Rights risk to persons in care.
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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:Gladys Kuizon
LICENSING EVALUATOR NAME:Sheena Chin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2024


LIC809 (FAS) - (06/04)
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