Internal Web Data

Department of
SOCIAL SERVICES

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408782
Report Date: 02/18/2020
Date Signed: 02/18/2020 05:04:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
ADMINISTRATOR:	MARIE NUNEZ		FACILITY TYPE:	840
ADDRESS:	521 WEST CAPITOL EXPRESSWAY		TELEPHONE:	(408) 978-1500
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95136
CAPACITY:	21	CENSUS: 19	DATE:	02/18/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Marie Nunez		TIME COMPLETED:	05:15 PM

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	Licensing Program Analyst (LPA) Dung Mac and Licensing Program Manager (LPM) Diana Stephenson met with Marie Nunez, Director, for an unannounced annual/random inspection. The school age program is Licensed in one room only. The school age program hours are from 1:30pm to 6:30pm. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. LPA and LPM toured the Facility both inside and outside during today's inspection. LPA and LPM observed all furniture and equipment is in good condition and safe for the children. The playground areas utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. LPA and LPM did not observe any bodies of water. LPA reviewed files for six children's and three staff (2 teachers and one aide) during today's inspection Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All staff files reviewed contain the required transcripts/verification of experiences and one teacher has current CPR and First Aid certifications on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). Director states that all children are picked up from the Facility by parents/authorized representatives. Continue on Page #2

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020

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

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/18/2020

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A review of staff records on 2/18/20 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA and LPM observed that the teacher/child ratio was in compliance during today's inspection. LPA and LPM observed 19 school age children with two staff during today's inspection. LPA and LPM observed that 3 children were not sign in and 3 children were not sign out. Marie understands the conditions, limitations, and capacity specifications of the Facility license. Marie understands that children shall be visually supervised at all times.

LPA and LPM observed that room are clean and safe for all children and staff. Drinking water is readily available for the children in each room and in the outdoor playground area via pitchers/disposable cups. LPA and LPM observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable. Director states that there are no weapons or firearms on the premises. There is a functioning carbon monoxide detector in the classroom.

LPA conducted an exit interview with Director. Type B deficiency was issued during today's inspection. Appeal rights were given to Marie. A Notice of Site Visit was issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/18/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/25/2020 Section Cited	1 2 3 4 5 6 7	Sign In and Sign Out: In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain, and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum
	8 9 10 11 12 13 14	include the following: The person who signs the child in/out shall use his/her full legal signature and shall record the time of day. This requirement is not met as evidenced C1-C3 were not signed out, C4-C6 were not sign in which poses a potential health, safety, and personal right risks to daycare children.	8 9 10 11 12 13 14
	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.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020

LIC809 (FAS) - (06/04)

Page: 3 of 3