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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434415820
Report Date: 06/15/2021
Date Signed: 06/15/2021 06:07:51 PM



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
05/12/2021 and conducted by Evaluator Araceli Almaraz
COMPLAINT CONTROL NUMBER: 07-CC-20210512082710
FACILITY NAME:KIDDIE ACADEMY OF ALMADEN VALLEYFACILITY NUMBER:
434415820
ADMINISTRATOR:OLIVIA LOPEZFACILITY TYPE:
850
ADDRESS:16607 ALMADEN EXPRESSWAYTELEPHONE:
(408) 752-4803
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:142CENSUS: 106DATE:
06/15/2021
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Lopez. OliviaTIME COMPLETED:
06:20 PM
ALLEGATION(S):
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Personal rights.
Admission procedure and parental and authorized representative rights.
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Almaraz, Celi conducted an on site complaint investigation inspection. LPA met with Director Lopez, Olivia. The purpose of today's inspection: To deliver investigation findings. LPA interviewed Director and reviewed supporting documents.

This agency has investigated the complaint/s alleging personal rights and Admission procedure and parental and authorized representative rights "facility allowed unathorized adults to pick up day care child" and "Facility is not following parental court order. “Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, 101223 (2) of Title 22, Division 12 & Chapter 1, is/are being cited on the attached LIC. 9099D.” There is one type B deficiency. A copy of this report was given to Director Lopez and appeal rights.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
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 4
Control Number 07-CC-20210512082710
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 ALMADEN VALLEY
FACILITY NUMBER: 434415820
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2021
Section Cited
CCR
101223(2)
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Personal Rights: (2) To be accorded safe, healthful and comfortable accommodations. This requirement was not met as evidenced by LPA obtained documentation that there was an unauthorized pick up of child/ren in care. The parental court order was not followed. This poses a potential risk to the health and safety of children in care.
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Director will sign and have all staff (and owner) sign a statement acknowledging only authorized persons may pick up children, in the event a court order exists this supersedes parental request/s. Director will send signed statement to LPA on or before 06/18/2021 via email.
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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: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
05/12/2021 and conducted by Evaluator Araceli Almaraz
COMPLAINT CONTROL NUMBER: 07-CC-20210512082710

FACILITY NAME:KIDDIE ACADEMY OF ALMADEN VALLEYFACILITY NUMBER:
434415820
ADMINISTRATOR:OLIVIA LOPEZFACILITY TYPE:
850
ADDRESS:16607 ALMADEN EXPRESSWAYTELEPHONE:
(408) 752-4803
CITY:SAN JOSESTATE: CAZIP CODE:
95120
CAPACITY:142CENSUS: 106DATE:
06/15/2021
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Lopez. OliviaTIME COMPLETED:
06:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Supervision.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day Licensing Program Analyst (LPA) Almaraz, Celi conducted an on site complaint investigation inspection. LPA met with Director Lopez, Olivia. The purpose of today's inspection: To deliver investigation findings. LPA interviewed Director and reviewed supporting documents.

This agency has investigated the complaint/s alleging supervision, facility failed to administer medication to child. "Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED." A copy of this report was given to Director Lopez and appeal rights.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Araceli AlmarazTELEPHONE: (408) 334-8551
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4