434417051-12-26-2024-07-CC-JSEA-DCWUAF-20250114142439

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434417051
Report Date: 12/26/2024
Date Signed: 12/26/2024 03:02:55 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/03/2024 and conducted by Evaluator Marilou Monico

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20241203090035

FACILITY NAME:	KINDERWOOD PRESCHOOL		FACILITY NUMBER:	434417051
ADMINISTRATOR:	CHEYENNE BOHN		FACILITY TYPE:	850
ADDRESS:	5560 ENTRADA CEDROS		TELEPHONE:	(408) 839-5669
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	69	CENSUS: 5	DATE:	12/26/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Fernanda Vargas		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are commingling daycare children.
Staff are utilizing an unauthorized facility space.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marilou Monico made a follow-up complaint investigation and to deliver findings. LPA met with Acting Site Director, Fernanda Vargas. Based on interviews, record review, and evidence gathered during the investigation process, the Department concludes that the facility staff were commingling children and utilizing off limit areas: office and staff areas on the second floor for the preschool children. The above allegations are thus found to be SUBSTANTIATED, meaning the allegations are valid because the preponderance of the evidence standard has been met.

Type B deficiencies are being cited on the attached LIC 9099-D.

Exit interview conducted and report was reviewed with the Acting Site Director, Fernanda Vargas.

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

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 07-CC-20241203090035

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 PRESCHOOL	FACILITY NUMBER: 434417051
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/30/2024 Section Cited CCR 101161(a)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	By POC due date: 12/30/24, Licensee to submit a written plan on how they will ensure that children from different programs will be physically separated and off limit areas will not be used for daycare.
	8 9 10 11 12 13 14	Based on interviews, record review, and evidenced gathered, staff were commingling children from different programs and utilizing off limit areas for the preschool children which poses a potential health, safety or personal rights risk to children in care.	8 9 10 11 12 13 14	Since this is a repeat violation within 12 months, an immediate civil penalty of $250 is hereby assessed.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/03/2024 and conducted by Evaluator Marilou Monico

PUBLIC

COMPLAINT CONTROL NUMBER: 07-CC-20241203090035

FACILITY NAME:	KINDERWOOD PRESCHOOL		FACILITY NUMBER:	434417051
ADMINISTRATOR:	CHEYENNE BOHN		FACILITY TYPE:	850
ADDRESS:	5560 ENTRADA CEDROS		TELEPHONE:	(408) 839-5669
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	69	CENSUS: 5	DATE:	12/26/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Fernanda Vargas		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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7
8
9

Staff does not ensure facility is operating in ratio.
Staff does not ensure other staff are qualified to care and supervise daycare children.

INVESTIGATION FINDINGS:

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13

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4