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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417060
Report Date: 07/13/2023
Date Signed: 07/18/2023 09:21:34 AM

Document Has Been Signed on 07/18/2023 09:21 AM - 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-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KIDANGO CESAR CHAVEZ EARLY LEARNING CENTERFACILITY NUMBER:
434417060
ADMINISTRATOR:JOSEFINA GARCIA MARQUEZFACILITY TYPE:
830
ADDRESS:2000 KAMMERER AVENUETELEPHONE:
(408) 901-8296
CITY:SAN JOSESTATE: CAZIP CODE:
95116
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 17DATE:
07/13/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Josefina Garcia MarquezTIME COMPLETED:
01:00 PM
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Licensing Program Analyst(LPA) Anna Morales and Licensing Program Manager(LPM) Gladys Kuizon conducted a Case Management- Lead Testing/Exceedance visit and met with Director Josefina Garcia Marquez.

During today's inspection LPA Morales requested and obtained the following documents; Self-Certification LIC9275, Sampling Checklist Form LIC9276, Facility Sketch LIC 999, fully labeled with locations of all water outlets, and full lead report. The lead exceedance readings for sample date 11/11/2022 found Action Level Exceedance (ALE) results in 3 outlets:

A (#1) = 9.6 ppb, B (#2) = 24 ppb, H (#8) = 6.8 ppb

During today's inspection, verification of passing lead test results for the above outlets' retesting on 05/03/2023 was obtained. All outlets show non-ALE results.

Type B deficiency cited and corrected during visit, exit interview conducted, and a copy of this report was reviewed with the Director Josefina Garcia Marquez. Appeal rights were reviewed and provided.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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 07/18/2023 09:21 AM - It Cannot Be Edited


Created By: Anna Morales On 07/13/2023 at 11:58 AM
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: KIDANGO CESAR CHAVEZ EARLY LEARNING CENTER
FACILITY NUMBER: 434417060

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2023
Section Cited

101700.3(b)(1)

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Lead Testing Written Directives 101700.3 (b)(1), a result with values 5.5 ppb or greater shall be deemed an Action Level Exceedance. This requirement was met as evidenced by:
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Facility repaired and resampled ALE outlets on 05/03/2023 and submitted proof of non-ALE results for all outlets.
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Lead testing conducted on 11/11/2022 showed ALE on 17 outlets in the facility. This posed a potential risk to children 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:Anna Morales
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2023


LIC809 (FAS) - (06/04)
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