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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408795
Report Date: 10/04/2023
Date Signed: 10/04/2023 08:29:10 PM

Document Has Been Signed on 10/04/2023 08:29 PM - 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 MORGAN HILLFACILITY NUMBER:
434408795
ADMINISTRATOR:NAKIA CENTENOFACILITY TYPE:
850
ADDRESS:15750 MONTEREY ROAD, SUITE 150TELEPHONE:
(408) 776-6800
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 36DATE:
10/04/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Nakia CentenoTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Case Management- Lead Testing/Exceedance inspection. LPA met with Director Nakia Centeno and explained the reason for the inspection. The purpose of this inspection is the Faucet A located in the kitchen had a result of 8.6ppb.

During today's inspection, LPA inspected Faucet A, which had the exceedance. Director stated that the faucet did get changed and they scheduled the retesting for 10/21/2023. There is a separate sink for food preparation and will be using the water from the food preparation sink to wash dishes. Director will submit LIC 999, LIC 9275, and LIC 9276 after retesting is completed.

A copy of the LIC 999, LIC 9275, and LIC 9276 was obtained during today's inspection.

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Director Nakia Centeno. A notice of site visit has been issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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 10/04/2023 08:29 PM - It Cannot Be Edited


Created By: Samantha Yip On 10/04/2023 at 10:59 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 MORGAN HILL
FACILITY NUMBER: 434408795

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/06/2023
Section Cited

101700.3(b)(1)

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Lead Testing Written Directives. A result with values of 5.5 ppb or greater shall be deemed an Action Level 8.6ppb, which poses a potential health and safety risk to children in care. Exceedance.
This requirement is not met as evidenced by:
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By POC 11/06/2023, Director stated that they will have Faucet A retested and submit test results, LIC 999, LIC 9275, and LIC 9276 to
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Faucet A has a result of
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Licensing.

Faucets has been replaced. There is a separate sink for food preparation, which will also be used to wash dishes.

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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:Samantha Yip
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2023


LIC809 (FAS) - (06/04)
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