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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417051
Report Date: 03/27/2024
Date Signed: 03/27/2024 04:01:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 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
02/15/2024 and conducted by Evaluator Sheena Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240215153211
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:69CENSUS: 61DATE:
03/27/2024
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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9
Staff did not ensure eating surfaces were clean and sanitized.
INVESTIGATION FINDINGS:
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On 3/27/24 at 9:50am Licensing Program Analyst (LPA) Sheena Chin conducted an unannounced complaint investigation and delivered the complaint investigation results for the above allegations. The director was not in the office when LPA arrived at the facility. The office assistant stated that the director was on 15-minute break. The director was back in the facility around 10:12 when LPA was on the 2nd floor. Around10:20am LPA met with the director, Cheyenne Bohn, and explained today’s visit.

During the course of this investigation, LPA observed the activities at the facility, reviewed documents of cleaning arrangements, & activities and interviewed the director, staff, and parents. Parents interviewed stated that they were not sure if eating surfaces were clean or sanitized as they didn’t have time to stay in the facility during mealtime. LPA observed that the facility used table clothes for room 4 & 5 while having lunch outdoors and that children in room 3 had lunch in the classroom. During the investigation LPA did not observe the eating surfaces were unclean.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 07-CC-20240215153211
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 PRESCHOOL
FACILITY NUMBER: 434417051
VISIT DATE: 03/27/2024
NARRATIVE
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Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview was conducted and this report was reviewed and discussed with the director, Cheyenne Bohn.
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: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2