Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434408782
Report Date: 08/08/2019
Date Signed: 08/08/2019 10:22:16 AM


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
06/21/2019 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20190621084427
FACILITY NAME:KIDDIE ACADEMY OF SAN JOSEFACILITY NUMBER:
434408782
ADMINISTRATOR:MARIE NUNEZFACILITY TYPE:
840
ADDRESS:521 WEST CAPITOL EXPRESSWAYTELEPHONE:
(408) 978-1500
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:21CENSUS: 18DATE:
08/08/2019
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Shefali MalhotraTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility staff failed to prevent inappropriate interactions between daycare children.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Subsequent Complaint Investigation at the Facility. LPA met with Supervisor, Shefali Malhotra and delivered the finding for the above allegation. Director, Marie Nunez was not present in the facility and Shefali Malhotra was authorized to sign the report. Marie arrived later and the report was discussed with her also.

Complainant alleges that facility staff failed to prevent inappropriate interactions between daycare children. During the investigation, LPA inspected the physical plant, reviewed records, and conducted interviews with staff, children and parents. LPA learned that Child 1 (C-1) was previously enrolled in the Center’s preschool program years ago where C-1 showed aggressive behavior. In June 2019, C-1 enrolled in the Center’s school age summer program. Staff was not made aware of C-1’s aggressive behavior, not provided necessary support and were not prepared to effectively manage C-1. During investigation process LPA learned that C-1 was physically removed from a situation by a staff person.

Continued on next page
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
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-20190621084427
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: KIDDIE ACADEMY OF SAN JOSE
FACILITY NUMBER: 434408782
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2019
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights: (a) The licensee shall ensure that each child is accorded the following personal rights:(2) to be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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By POC Due Date 09/09/19 Director agreed to submit a written statement on how they will identify manage and communicate the needs of a child who displays challenging behavior. Director will facilitate a professional child behavior management training program to be provided to all staff. Once a training program is identified Director will provide the training program content to CCLD for approval. Once training is completed by all staff, Director will submit proof of training to CCLD by POC due date.
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Staff was not aware of C-1’s aggressive behavior, not provided tools and support to effectively manage C-1. C-1 was physically removed from a situation by a staff person. C-1 physically kicked and slapped at least one other child. This poses a potential risk to the health and safety of 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: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 07-CC-20190621084427
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: KIDDIE ACADEMY OF SAN JOSE
FACILITY NUMBER: 434408782
VISIT DATE: 08/08/2019
NARRATIVE
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On at least two occasions C-1 physically kicked and slapped at least one other child. Based on the interviews and documents obtained by LPA the facility violated the personal rights of C-1 and other children in care by failing to provide a safe, healthful and comfortable accommodations, furnishings and equipment to meet the needs of children in care.

Based on the information and documents obtained by LPA, the preponderance of evidence standard has been met. Therefore, the allegation: Facility staff failed to prevent inappropriate interactions between daycare children is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on the next page. Exit interview was conducted, where this report, the citation, plan of correction, and appeal rights were discussed with the Supervisor and Director.

There were 18 children and 2 staff present at the time of inspection.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Monica MathurTELEPHONE: (408) 334-8312
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 3