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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700583
Report Date: 11/03/2022
Date Signed: 11/03/2022 03:19:26 PM

Document Has Been Signed on 11/03/2022 03:19 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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BUILDING KIDZ OF DUBLINFACILITY NUMBER:
015700583
ADMINISTRATOR:MYERS, CAROLYNNFACILITY TYPE:
850
ADDRESS:6351 DUBLIN BOULEVARDTELEPHONE:
(650) 777-5301
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
11/03/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Caroylnn Myers & Jessica LasherTIME COMPLETED:
03:40 PM
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A Prelicensing inspection was conducted today 11/03/2022 by Licensing Program Analyst (LPA) Melanie Otsuji. LPA met with Compliance Manager, Jessica Lasher and Center Director, Carolynn Myers. The applicant has submitted a NEW application for a PRESCHOOL license for 60 preschoolers including up to 12 toddlers in the toddler option program. The program will operate from 7AM - 6PM, Monday through Friday, in 6 classrooms (Classrooms 101, 102, 103, 104 105 and 106). Classroom 105 will serve the toddler option program with up to 12 toddlers. A health and safety inspection was conducted inside and outside and the measurements are as follows:

INDOORS: 2942.45 square feet = 84 children
OUTDOORS: 1946.36 square feet = 26 children

The center has obtained an approved fire inspection clearance from the Dublin Fire Prevention Services on 10/10/2022.

Building is located off of Dublin Boulevard nearest La Quinta Inn and Suites. Parents will walk through the entry way, check in their child and escort them to their classrooms. Classrooms are located down the hallway to the right of the entryway. Building has a second floor and Director understands that no children shall be allowed on the second floor of the building. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 4 toilets, 1 urinal and 5 sinks available for children use. Staff toilet is located in the Director's office. Facility will provide AM/PM snacks and will have catered lunch brought in via ChoiceLunch. Menu will be posted at least one week in advance in a place visible for the authorized representative to see. The Director's office and staff bathroom will serve as isolation areas for sick children. Mats were observed today.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BUILDING KIDZ OF DUBLIN
FACILITY NUMBER: 015700583
VISIT DATE: 11/03/2022
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This facility plans to provide Incidental Medical Services - IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 The play yards are fenced in all around. Building overhang and umbrellas provide sufficient shade in the play yard. The center has pitchers and cups, as well as water bottles for indoor and outdoor activities. No cleaning agents were found stored with food. There is a refrigerator available. First aid supplies are available in the center. There is a working telephone on site. Facility will utilize an electronic sign in/out software that has a separate PIN/login for each authorized representative. Paper sign in/out sheets will be utilized should the electronic software be unavailable.

Carolynn Myers is a fully qualified preschool director and has completed 16 hours of health and safety training including pediatric CPR and First Aid. Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BUILDING KIDZ OF DUBLIN
FACILITY NUMBER: 015700583
VISIT DATE: 11/03/2022
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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

A license for 60 preschool children (operating out of 6 rooms - Rooms 101, 102, 103, 104, 105 and 106) which includes the option to have up to 12 toddlers in the toddler option program will be issued effective today, 11/3/2022. Yard waiver to be posted with license upon receipt.



Exit interview conducted with Compliance Manager, Jessica Lasher.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Melanie Otsuji
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
LIC809 (FAS) - (06/04)
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