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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408783
Report Date: 06/01/2022
Date Signed: 06/01/2022 11:26:02 AM

Document Has Been Signed on 06/01/2022 11:26 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:
434408783
ADMINISTRATOR:MARIE NUNEZFACILITY TYPE:
830
ADDRESS:521 WEST CAPITOL EXPRESSWAYTELEPHONE:
(408) 978-1500
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 8DATE:
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 tour of facility, staff member (S1) present in infant room was not fingerprint cleared. Staff member present is fingerprint cleared for toddler license only.

LPA advised that staff member cannot be present in infant or preschool classrooms until fingerprint clearances have been transferred for staff member.

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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
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 11:26 AM - It Cannot Be Edited


Created By: Cortney Nelson On 06/01/2022 at 10:22 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KIDDIE ACADEMY OF SAN JOSE
FACILITY NUMBER: 434408783

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2022
Section Cited
CCR
101170(e)(2)

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101170 Criminal Record Clearance (e) All individuals subject to criminal record review...shall prior to working...in a licensed facility... (2) request a transfer of criminal record clearance..

This requirement was not met as evidenced by:
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Licensee will submit California criminal clearance transfer request for staff member and will not utilize staff member in other classrooms until cleared. Transfer request should be completed for staff member by 6/3/2022.
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Based on observation and interview, staff member present in infant classroom does not have fingerprint clearances for infant license which poses a potential 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 Segura
LICENSING EVALUATOR NAME:Cortney Nelson
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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