Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404854
Report Date: 05/09/2016
Date Signed 05/09/2016 03:56:58 PM

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:KIDANGO OHLONE CHYNOWETH CENTERFACILITY NUMBER:
434404854
ADMINISTRATOR:CONNIE LOMASFACILITY TYPE:
850
ADDRESS:5312 TERNER WAYTELEPHONE:
(408) 979-1670
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:32CENSUS: 15DATE:
05/09/2016
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Connie LomasTIME COMPLETED:
04:00 PM
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Unannounced case management visit made by analyst, Pam Burkett. Met with Director, Connie Lomas.

There were 15 preschool children present with 3 teachers.

The purpose of this visit was to inquire about an incident that occurred on 4/25/16. There was a small fire in a staff bathroom.

LPA observed the bathroom fan and there is no damage to the fan. There is no smell of smoke.

Director, Connie, stated that all of the children were evacuated safely. The fire department arrived within minutes. They are located right down the street. The children and teachers remained outside for approximately 10 minutes. The fire department came out and stated it is safe for everyone to return to the day care.

Director stated at the time of the incident there was no smoke smell.

The fire department did not give the director anything in writing that the day care was safe. They just stated it is "all clear".

No deficiencies were cited during this visit.

The notice of cite visit must be posted for 30 days.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Pam BurkettTELEPHONE: (408) 324-2111
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2016
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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