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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417051
Report Date: 04/09/2024
Date Signed: 04/11/2024 07:33:44 AM

Substantiated


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
03/18/2024 and conducted by Evaluator Sheena Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240318161740
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: 53DATE:
04/09/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Cheyenne BohnTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility is operating out of ratio.
INVESTIGATION FINDINGS:
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On 4/9/24 Licensing Program Analyst (LPA) Sheena Chin conducted a unannounced complaint inspections and met with the director, Cheyenne Bohn, today. The purpose of LPA’s visit was to continue the investigation and deliver the investigation finding for the above allegation.

During investigations, LPA observed daily activities at the facility and review files. The preschool was short of staff and out-of-ratio violations were observed. Based on the observations, the preponderance of evidence standard has been met, therefore the above allegation.“Facility is operating out of ratio." is found to be SUBSTANTIATED.

A type A deficiency is being cited on LIC9099D.

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

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
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 5
Control Number 07-CC-20240318161740
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: 04/09/2024
NARRATIVE
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Exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were reviewed and discussed with the director, Cheyenne Bohn.

Notice of site visit was given and must remain posted for 30 days.

LPA advised the director to print out this licensing report and deficiency report for parents to review and have parents sign LIC 9224 forms. LPA advised the director that a copy of this report shall be provided to parent/guardian of any newly enrolled children for the next 12 months. LPA advised the director to post this report and the Notice of Site Visit for 30 days. Failure to maintain postings as required will result in an immediate $100 civil penalty.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 07-CC-20240318161740
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
04/09/2024
Section Cited
CCR
101216.3
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101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance

This requirement was not met as evidenced by :
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The facility is hiring more staff and two teachers will start working tomorrow (4/10/24) and one teacher was on board on 4/1/24. The director will send LPA the attendance records of the two new teachers.
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Based on observation, interview and record review, the licensee did not comply with the regulations above. The facility did not maintain required teacher ratio, which poses an immediate Health, Safety, and 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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Sheena Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5