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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408797
Report Date: 09/08/2022
Date Signed: 09/09/2022 07:58:01 AM

Document Has Been Signed on 09/09/2022 07:58 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 MORGAN HILLFACILITY NUMBER:
434408797
ADMINISTRATOR:NAKIA CENTENOFACILITY TYPE:
830
ADDRESS:15750 MONTEREY ROAD, SUITE 150TELEPHONE:
(408) 776-6800
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 7DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Nakia CentenoTIME COMPLETED:
04:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced Required- 1 Year inspection. LPA met with Director Nakia Centeno and explained the reason for the inspection. Present during today's inspection were seven (7) infants and at least three (3) staff.

There is a board to post required postings, such as license, notification of parents, and car seat law. The hours of operation are Monday through Friday 7AM to 6PM. There is working phone on the premise. LPA reviewed sign in/sign out.

LPA toured the inside and outside of the facility with Director Nakia. Disinfectant, cleaning supplies, and other items that could pose a risk to children were inaccessible. Toys and equipment were observed to be age appropriate. Changing table have a padding and was within reach of a sink. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. The last disaster drill was conducted on 04/24/2022. Director stated that there are no weapons, such as firearms, stored on the premise.

The outdoor activity was fenced. Area around play structure have resilient material. There are toys and equipment for the children. Shaded rest area is provided through trees. There were no bodies of water observed during today's inspection.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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 MORGAN HILL
FACILITY NUMBER: 434408797
VISIT DATE: 09/08/2022
NARRATIVE
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-------------------continuation of 809 dated 09/08/2022 page 1-------------------

LPA reviewed sleep check. Facility only does sleep check for infant 12 months and under. LPA discussed with Director that sleep check are required for children 24 months and under. C-1 and C-2 does not have LIC 9227: Individual Infant Sleeping Plan on file. LPA discussed with Director that it is required for children 12 months and under. LPA observed that one of the cribs had a sheet that was not tightly fitted on crib mattress and there were signs and pillows hanging on the side of the crib. LPA discussed with Director that all sheets need to be tight fitted and there cannot be anything happing on the side of the crib. LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Facility provides meals and snacks to the older infants. Menu was observed to be posted. There is fridge to store bottles and food from home. Bottles and food had the child's name and date on it. Drinking water is provided through sippy cups and individual water bottles. Kitchen use to prepare and store food was observed to be clean.

Facility does not currently provide Incidental Medical Services (IMS). For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm
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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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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 MORGAN HILL
FACILITY NUMBER: 434408797
VISIT DATE: 09/08/2022
NARRATIVE
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------------------continuation of 809 dated 09/08/2022 page 2--------------------

Seven (7) children's files were reviewed during today's inspection. The record reviewed include but not limited to parent's rights, Needs and Service Plan, and physician's report. LPA observed that C-1, C-3, and C-4 did not have physician's report in file. C-1's Needs and Service Plan was last updated on 05/25/2022. LPA reminded the Director that the Needs and Service Plan needs to be updated quarterly. Director stated that she will send a copy of the updated facility roster to Licensing by 09/16/2022.

Three (3) staff files were reviewed during today's inspection. The records reviewed included but not limited to education credit, Health Screening, Mandated Reporter training, and immunization records. S-1 was missing immunization records for Measles, Pertussis, and influenza. S-1 was hired on 08/09/2022 and does not have Health Screening and TB test on file. LPA observed that S-2 with in the infant room by herself and had only completed 4 quarter units in infant/toddler. S-1 was left alone in the toddler room during naptime. Transcript for S-1 on file showed that she completed 8 quarter units and has not complete at least 3 semester units in infant/toddler. S-1 has additional transcripts on file but not does not show completion. S-1 is enrolled to completed additional units. LPA discussed with Director about semester and quarter unit conversation. Director will send proof that S-2 is enrolled to complete at least 3 semester units in infant/toddler. Director understands that a fully qualified teacher needs to have completed at least 3 semester units in infant/toddler. There is a staff who completed the CPR/1st Aid training on 06/2021 through Medic 1st Aid. There is no proof on the card that it is EMSA approved. Director will send proof that program is EMSA approved.


----------------------continues on 809 dated 09/08/2022 page 4--------------------
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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Document Has Been Signed on 09/09/2022 07:58 AM - It Cannot Be Edited


Created By: Samantha Yip On 09/08/2022 at 02:23 PM
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: 434408797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(2)(B)
Responsibility for Providing Care and Supervision for Infants
(B) Staff shall physically check on sleeping infant(s) every 15 minutes and document the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above. Facility is not checking infants in the toddler room and documenting it, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/15/2022
Plan of Correction
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Director stated that they will start sleep checks in the toddler room and document it. Director will send proof to Licensing.
Type B
Section Cited
CCR
101170(e)(2)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 3 persons, which poses a potential health, safety or personal rights risk to persons in care. S-1 has cleared fingerprints and is associated to the preschool license. S-1's fingerprints were not transferred to infant license.
POC Due Date: 09/09/2022
Plan of Correction
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Director transferred S-1's fingerprints to the infant license during today's inspection, but did not go through. Director will submit LIC 9182 with a valid ID to Licensing.
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: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022


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Document Has Been Signed on 09/09/2022 07:58 AM - It Cannot Be Edited


Created By: Samantha Yip On 09/08/2022 at 02:23 PM
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: 434408797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101416.2(c)(1)(A)
Infant Care Teacher Qualifications and Duties
(c) To be a fully qualified infant care teacher, a teacher shall have the following: (1) Completion, with passing grades, of 12 postsecondary semester or equivalent quarter units in early childhood or child development education at an accredited or approved college or university. (A) At least three of the units required in (c)(1) above shall be related to the care of infants or shall contain instruction specific to infants.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. S-2 completed 4 quarter units in infant/toddler, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2022
Plan of Correction
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Director will send proof that S-2 is enrolled in infant/toddler course.
Type B
Section Cited
CCR
101220(a)
Child's Medical Assessments
(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 7 persons, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/11/2022
Plan of Correction
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By POC, Director will submit physician's report for C-1, C-3, and C-4 to Licensing.
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: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022


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Document Has Been Signed on 09/09/2022 07:58 AM - It Cannot Be Edited


Created By: Samantha Yip On 09/08/2022 at 02:23 PM
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: 434408797

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101419.2(b)(2)
Infant Needs and Services Plan
(b) The needs and services plan shall be in writing and shall include the following: (2) Infants up to 12 months of age shall have a completed Individual Infant Sleeping Plan [LIC 9227 (3/20)], which is incorporated by reference.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 out of 2 persons, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/15/2022
Plan of Correction
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By POC 09/15/2022, Director will send a copy of LIC 9227 for C-1 and C-2 to Licensing.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: 09/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022


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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 MORGAN HILL
FACILITY NUMBER: 434408797
VISIT DATE: 09/08/2022
NARRATIVE
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--------------continuation of 809 dated 09/08/2022 page 3-----------------------

S-1 has cleared fingerprints and is associated to the preschool license #434408795. Director transferred S-1 fingerprints to infant license during today's inspection. S-1's fingerprints did not transfer over. Director will submit LIC 9182 with a valid ID to Licensing. All other staff present have cleared fingerprints or exemption. Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Director will submit the following:
- LIC 9227 for C-1 and C-2
- Sleep Log for Toddler Room
- Facility Roster
- Health Screening, TB test, Immunization Records for S-1
- Proof of Enrollment in course for S-2 and exception request for S-2 to be an infant teacher
- TB test for S-2
- proof that CPR/1st Aid training is EMSA approved

As a result of this inspection, Type B citations and technical violations were issued. A civil penalty of $100 was assessed for Caregiver Background Check. Exit interview conducted and report was reviewed with Director Nakia Centeno. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
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