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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417051
Report Date: 08/22/2024
Date Signed: 08/22/2024 11:07:56 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
07/31/2024 and conducted by Evaluator Liridon Fici
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20240731113857
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: 48DATE:
08/22/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cheyenne BohnTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Staff are commingling day care children.
INVESTIGATION FINDINGS:
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On 8/22/2024, at 9:00 AM, Licensing program analyst (LPA), Doni Fici arrived unannounced to conduct a subsequent complaint investigation. LPA was greeted by Director, Cheyenne Bohn and explained the purpose of today's visit.

During the course of the investigation. LPA interviewed three (3) staff members, three (3) children and 14 parents. LPA requested and obtained the following documents: Staff roster, activities schedule, and Preschool roster with contact information.

It was alleged that; Staff are commingling day care children. Based on interviews conducted with three (3) staff members, 3 children, and 14 parents, seven (7) out of 14 parents stated they have seen school age children playing together with preschool children during operation hours.
Continue on Lic9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
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
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
07/31/2024 and conducted by Evaluator Liridon Fici
COMPLAINT CONTROL NUMBER: 07-CC-20240731113857

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: 48DATE:
08/22/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cheyenne BohnTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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9
Staff do not prevent rough interactions between children in care.
INVESTIGATION FINDINGS:
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On 8/22/2024, at 9:00 AM, Licensing program analyst (LPA), Doni Fici arrived unannounced to conduct a subsequent complaint investigation. LPA was greeted by Director, Cheyenne Bohn and explained the purpose of today's visit.

During the course of the investigation. LPA interviewed three (3) staff members, three (3) children and 14 parents. LPA requested and obtained the following documents: Staff roster, activities schedule, and Preschool roster with contact information.

It was alleged that; Staff do not prevent rough interactions between children in care. Based on interviews conducted with staff, and parents, three (3) out of 3 staff stated children do not play roughly and are kind to other children. During interviews with parents, LPA was advised that parents do not see older children rough playing with younger children.
Continue to Lic9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 07-CC-20240731113857
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: 08/22/2024
NARRATIVE
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Based on interviews, and evidence gathered during the course of the investigation, it is concluded that although the allegations noted on this complaint may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. The allegations are UNSUBSTANTIATED.

A Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted with Director, and a copy of this report review and provided.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 07-CC-20240731113857
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: 08/22/2024
NARRATIVE
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Based on interviews, and evidence gathered during the investigation process, the Department concludes that, staff are commingling day care children. 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 Notice of Site Visit was given and must remain posted for 30 days.

Exit interview conducted with Director, and a copy of this report review and provided along with appeal rights.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 07-CC-20240731113857
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: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied: Appeal Not Submitted Timely
Type B
08/29/2024
Section Cited
CCR
101161(a)
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101161(a) Limitations on Capacity
(a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.

This requirement is not met as evidenced by:
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Licensee agreed to submit a self-certification letter on section 101161(a)- Limitations on Capacity, signed, dated and submitted to CCL by POC due date.
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Based on observation and record review, the licensee did not comply with the section cited above by allowing school aged children to commingle between preschool kids which poses a potential health, safety 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.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
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