Building Kidz Santa Clara

(POC) due date, may result in a civil penalty assessment. Susy Cervantes NAME OF LICENSING PROGRAM MANAGER: Deanna Villagrana NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/14/2026 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2026 LIC809 (FAS) - (06/04) Page: 3 of 3

(POC) due date, may result in a civil penalty assessment.

due date, 06/13/2025, Licensee will submit a proof of in-service training conducted to staff regarding Personal rights of the children to the department. Licensee will also submit a written plan of action indicating what steps will be implemented to ensure that each child in day care center is accorded the personal rights within Title 22 regulations section code: 101223 requirements to the department. 8 9 10 11 12 13 14 Based on evidence gathered and review of video clip of 04/24/25 of Room D2 during nap time where staff(S1&S2) are present, with Licensee Representative and Director throughout the investigation, staff(S1) handled day care child(C1) in a rough manner, which poses an immediate risk to the health, safety and personal rights of children in care. 8 9 10 11 12 13 14 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

has been cleared during today's investigation. LPA advised Licensee Representative about monitoring clearances for all new staff members and correctly completing Livescan form. 8 9 10 11 12 13 14 Based on records review and interviews, Licensee allowed a staff(S1)to work at the facility without criminal record clearances since 01/22/2025, which poses a potential risk to the health, safety, and personal rights of children in care. 8 9 10 11 12 13 14 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Belinda Devall NAME OF LICENSING PROGRAM MANAGER: Mandeep Kaur NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/04/2025 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2025 LIC809 (FAS) - (06/04) Page: 3 of 3

due date, 06/18/2025, Licensee will submit the copy of the attendance sheet of all the attendees regarding the training on Supervision policy for all staff to the department. Copy of training material of Supervision policy is obtained during today's investigation. 8 9 10 11 12 13 14 Based on interviews and evidence gathered, LPA reviewed and observed in the video clip of 04/28/25 and 04/24/25 classroom D2 with Director and Licensee representative that the children(C1, C2 &C3) in video clip of 04/28/25 and a few children in video clip of 04/24/25, care and supervision as necessary to meet the children's needs was not provided, which poses a potential risk to the health, safety, and personal rights of children in care. 8 9 10 11 12 13 14 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.