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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408782
Report Date: 06/01/2022
Date Signed: 06/01/2022 11:27:17 AM


Document Has Been Signed on 06/01/2022 11:27 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



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: 4DATE:
06/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ravinder Gaud & Marie NunezTIME COMPLETED:
11:35 AM
NARRATIVE
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Licensing Program Analyst (LPA), Cortney Nelson, met with owner, Ravinder Gaud, and explained purpose of visit. Upon arrival, LPA toured inside and outside of the facility. Site Director, Marie Nunez, arrived to the facility around 10:20AM.

During inspection, staff member (S1), arrived at the facility. Fingerprint clearances are pending for staff member and she does not have active fingerprint clearances.

LPA advised that staff member cannot be present in the facility until fingerprint clearances have been obtained for staff member. LPA additionally advised that fingerprint clearances for staff member are transferred to all three licenses as staff member is currently associated to toddler license only.

As a result of todays inspection, deficiencies have been cited, see 809-D.

Exit interview conducted with owner, Ravinder Gaud and Site Director, Marie Nunez.

A NOTICE OF SITE VISIT HAS BEEN GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
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 06/01/2022 11:27 AM - It Cannot Be Edited

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: 06/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
06/02/2022
Section Cited

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101170 Criminal Record Clearance (e) All individuals subject to criminal record review...shall prior to working...in a licensed facility... (1) obtain a California clearance... as required by the Department.

This requirement was not met as evidenced by:
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Based on observation, record review, and interview, staff member present at the facility did not have California criminal background clearances prior to starting employment at the facility which poses an immediate risk to the health, safety, and personal rights 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: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Cortney NelsonTELEPHONE: (916) 956-5037
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
LIC809 (FAS) - (06/04)
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