<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434417192
Report Date: 06/04/2025
Date Signed: 06/04/2025 03:25:10 PM

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
05/07/2025 and conducted by Evaluator Mandeep Kaur
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20250507090337
FACILITY NAME:BUILDING KIDZ SANTA CLARAFACILITY NUMBER:
434417192
ADMINISTRATOR:AJANTA DASFACILITY TYPE:
860
ADDRESS:1500 LOS PADRES BLVD,#110,#111TELEPHONE:
(408) 758-1883
CITY:SANTA CLARASTATE: CAZIP CODE:
95050
CAPACITY:79CENSUS: 56DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Miao Li and Hong NiTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Day care child getting hit by other day care children.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst(LPA) Mandeep Kaur met with Licensee representative, Miao Li and Director, Hong Ni for an unannounced follow up complaint investigation. Purpose of today's investigation: deliver investigation findings. LPA conducted observations, interviewed staff, reviewed records, reviewed staff files and gathered evidence during the investigation. LPA toured inside areas of the facility during investigation.

LPA interviewed Director and Licensee representative and reviewed two staff(S1 & S5) files during today's investigation. During today's investigation, LPA reviewed the video clip of classroom D2, of 04/28/2025, where staff (S1 and S2) were present with children and the video clip of 04/24/2025, where Staff (S5 & S6) were present during nap time in classroom D2, with Licensee Representative and Director.

**Continue on next page**
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
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-20250507090337
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: BUILDING KIDZ SANTA CLARA
FACILITY NUMBER: 434417192
VISIT DATE: 06/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on interviews, evidence gathered and records review, day care child is getting hit by other day care children are due to lack of care and supervision as necessary to meet the children's needs. It is observed in the video clip of 04/28/25. Staff (S1) was, on the carpet, engaged with other children during circle time on a carpet and staff (S2) had their back towards child(C3) and right side towards children (C1&C2). As staff (S1) was engaged with other children during circle time activity and staff (S2) was observed to be recording the circle time activity. Children (C1 and C2) were observed to be getting into each other and child(C3) was observed to be by themselves in a far back of the classroom. Staff(S1 & S2) did not intervene in the situation between children (C1 & C2) till child (C1) bit child (C2) as observed in the video clip. Child (C3) was still by
themselves in a far back of the classroom without care and supervision as necessary to meet the child's needs as staff(S1) is still engaged with children during circle time and staff (S2) is helping children (C1 &C2) after the biting incident happened. It is observed in the video clip of 04/24/25 that Staff (S5 & S6) were present during nap time and care and supervision as necessary to meet the children's needs was not provided. LPA, Director and Licensee representative observed in the video clip of 04/24/25 that one child was touching another child in the middle of the room and staff(S5&S6) did not intervene. Director and Licensee representative self-admitted that there is a supervision issue as observed in both of the video clips. Licensee representative states that the material to conduct the training on supervision policy with staff, is ready and training for all staff on supervision will be completed by end of next week, June 13, 2025. The allegation noted above is thus found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met.

Copy of child care roster, personnel report and copy of training material of Supervision policy is obtained during today's investigation.

One "Type B" deficiency is being cited on the attached LIC 9099-D as a result of the Substantiated complaint investigation. Appeal rights provided.

Exit interview conducted and report was reviewed with Licensee Representative, Miao Li and Director, Hong Ni.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 07-CC-20250507090337
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: BUILDING KIDZ SANTA CLARA
FACILITY NUMBER: 434417192
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
06/18/2025
Section Cited
CCR
101229(a)
1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision: (a)The licensee shall provide care and supervision as necessary to meet the children's needs.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
By Plan of correction due date, 06/18/2025, Licensee will submit the copy of the attendance sheet of all the attendees regarding the training on Supervision policy for all staff to the department. Copy of training material of Supervision policy is obtained during today's investigation.
8
9
10
11
12
13
14
Based on interviews and evidence gathered, LPA reviewed and observed in the video clip of 04/28/25 and 04/24/25 classroom D2 with Director and Licensee representative that the children(C1, C2 &C3) in video clip of 04/28/25 and a few children in video clip of 04/24/25, care and supervision as necessary to meet the children's needs was not provided, which poses a potential risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14
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: Belinda Devall
LICENSING EVALUATOR NAME: Mandeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5