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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004591
Report Date: 09/14/2021
Date Signed: 09/15/2021 03:24:19 PM

Document Has Been Signed on 09/15/2021 03:24 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BUILDING KIDZ PACIFICAFACILITY NUMBER:
414004591
ADMINISTRATOR:WHEATLY, HALIEFACILITY TYPE:
850
ADDRESS:401 PALOMA AVENUETELEPHONE:
(650) 784-1479
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY: 72TOTAL ENROLLED CHILDREN: 0CENSUS: 35DATE:
09/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Liberty RosarioTIME COMPLETED:
01:45 PM
NARRATIVE
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On September 14, 2021 at 09:35 AM, Licensing Program Analyst (LPA) Cowan met with new director, Liberty Rosario, for a random annual inspection. Purpose of the inspection was explained. Present, in the facility are director, 5 staff, and 35 children in care. Facility is operating within the capacity and is in compliance with staff / child ratio on this day. Facility operates day care Monday to Friday from 07:30 AM to 05:30 PM. Facility consist of three classrooms: Sunshine, Starlight, and Moonlight.
With director, LPA inspected the day care rooms and play yard. LPA observed facility has built in smoke detector and fire extinguishers, carbon monoxide detector, fully charged fire extinguisher, and working telephone on site. All cleaning solutions, poisons and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age appropriate furniture. Facility floor is in good repair and free of any hazards.

There are first aid supplies available for the classrooms. All bathrooms are in working condition. All storage containers for solid waste fitted lids. All food is stored properly to avoid contamination. Facility has a sufficient amount of sleeping matts available. Bottles of water and other items provided by the parents are labeled and stored appropriately. Food preparation area is free of litter. Food is stored adequately to prevent contamination. Play yard is free of hazards. There is a sufficient amount of cushion material in the play yard to help absorb the impact of falls. At 10:15, LPA observed that there was no water or shade in available for children on the play yard. This is a possible risk for children in care. LPA will issue a type B citation this day.
Report continues on next page……….
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BUILDING KIDZ PACIFICA
FACILITY NUMBER: 414004591
VISIT DATE: 09/14/2021
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Continuation from previous page .............
LPA observed that facility is using electronic sign in / out. LPA collected a print-out of sign in/out. Facility has license and all other required documents posted and visible for the public. A monthly menu is posted in each class. Director states that a monthly menu is emailed to parents. Facility’s last emergency drill was conducted 9/3/21 and is properly logged. At 11:30 AM, LPA reviewed the facility records. LPA reviewed 5 random children's files. All children's files are complete with all required Licensing documents. LPA reviewed 5 random staff's files. At 11:45, LPA observed that two teachers did not have current Mandated Reporter Training. This poses a possible risk for children in care. LPA will issue a type B violation.

Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed some completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

Incidental Medical Services (IMS) policy was discussed. Director submitted IMS policy to LPA this day. 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
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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Document Has Been Signed on 09/15/2021 03:24 PM - It Cannot Be Edited


Created By: April Cowan On 09/14/2021 at 12:42 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BUILDING KIDZ PACIFICA
FACILITY NUMBER: 414004591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/15/2021
Section Cited
CCR
101239.2(a)

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101239.2 Drinking Water
(a) Drinking water from a noncontaminating fixture or container shall be readily available both indoors and in the outdoor activity area. This requirement is not met as evidenced by:
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Director agrees bring outdoor water dispenser for all children outside during play. Director states that this will begin 9/15/21. Director agrees to send LPA a picture of the new dispenser in use.
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During the inspection, LPA observed that children in the play yard did not drinking water available. This poses a possible health and safety risk to children in care.
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Type B
09/17/2021
Section Cited
CCR101238.2(b)(1)

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101238.2 Outdoor Activity Space
(b) The outdoor activity space shall be situated to: (1) Provide a shaded rest area for the children. This requirement was not met as evidenced by:
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Director agrees to replace shade in children's play area by 9/17/21 and send LPA a picture of the replacement.
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During inspection LPA observed that the shaded area in play yard had been removed. Director states that it was removed 2 months ago. This poses a possible risk to children in care.
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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:Garfield Leung
LICENSING EVALUATOR NAME:April Cowan
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021


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Document Has Been Signed on 09/15/2021 03:24 PM - It Cannot Be Edited


Created By: April Cowan On 09/14/2021 at 01:02 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BUILDING KIDZ PACIFICA
FACILITY NUMBER: 414004591

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2021
Section Cited
HSC
1596.8662(4)(b)(1)

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1596.8662(4)(b)(1) 1596.8662
Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion
(4) The department shall comply with the Dymally-Alatorre Bilingual Services Act of 1973 (Chapter 17.5 (commencing with Section 7290) of the Government Code), which includes, among alternative communication options, providing the same type of training materials in any non-English language spoken by a substantial number of members of the public whom the department serves.
(b) (1)   On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement was not met as evidenced by:
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Director agrees to have staff take training and submit a copy to LPA no later than 9/24/21.
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During record review, LPA observed two staff did not have current Mandated Reporter Training Certificates. This posses a possible risk to children in care.
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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:Garfield Leung
LICENSING EVALUATOR NAME:April Cowan
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021


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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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BUILDING KIDZ PACIFICA
FACILITY NUMBER: 414004591
VISIT DATE: 09/14/2021
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Continuation from previous page .............

LPA discussed children's bedding, storage of children's snacks and its preparation, medication storage, play yard flooring, and mask wearing for children 2 and above.

Director supplies LPA with updated telephone number and email address for facility.

> See next page for deficiencies.

This report must be available in the facility for public review. Notice of site visit was observed being posted. Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

The copy of this report is reviewed and provided to the director. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
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