Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413137
Report Date: 08/21/2017
Date Signed 08/21/2017 12:31:46 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 CHYNOWETH INFANTFACILITY NUMBER:
434413137
ADMINISTRATOR:VIRGINIA FAGUNDESFACILITY TYPE:
830
ADDRESS:5312 TERNER WAYTELEPHONE:
(408) 979-1670
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:8CENSUS: 7DATE:
08/21/2017
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Virginia FagundesTIME COMPLETED:
12:45 PM
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Case Management inspection made by LPA Pam Burkett met with Site Director Virginia Fagundes for a request to increase the infant license from 8 to 12. LPA toured the facility inside and out, as well as measured the indoor space. There is only one crib in the center. There are 8 cots. Administrator stated they do not plan to accept children under 18 months. There were 6 children over 2 years old today (ranging from 25 months to 34 months).

Indoor measurements are as follows:
INFANT ROOM 1 20.667 x 14.417 = 297.956 minus 7.638 (encumbered space) = 290.318

INFANT ROOM 2 12.500 x 10.333 = 129.163
2.500 x 4.750 = 11.875

TOTAL INDOOR SPACE: 431.356 sq. ft. divided by 35 = 12 children

Measurements for the playground were used from the visit made on 9/3/14.

TOTAL OUTDOOR SPACE: 923.417 sq. ft. divided by 75 = 12 children

There are only 8 cots and one crib.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Pam BurkettTELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2017
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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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: KIDANGO CHYNOWETH INFANT
FACILITY NUMBER: 434413137
VISIT DATE: 08/21/2017
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The increase will not be approved until a new LIC200 Application is submitted for ages 18 months to 2 years or the infant license is closed and the preschool adds a toddler option.

Type B deficiency was issued during the inspection. Deficiency, Plan of Correction (POC), and Appeal Rights discussed with the Director. Appeal Rights provided to the Director. Exit interview conducted with the Director.


SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Pam BurkettTELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2017
LIC809 (FAS) - (06/04)
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