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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004679
Report Date: 07/21/2021
Date Signed: 07/21/2021 11:28:08 AM

Document Has Been Signed on 07/21/2021 11:28 AM - 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 KIDZFACILITY NUMBER:
414004679
ADMINISTRATOR:WHEATLY, HALIEFACILITY TYPE:
830
ADDRESS:1496 ADOBE DRIVETELEPHONE:
(650) 735-5748
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY: 18TOTAL ENROLLED CHILDREN: 0CENSUS: 13DATE:
07/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Anabel Avalos/Mercedes ShidaTIME COMPLETED:
11:30 AM
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LPA Kaur made an unannounced required annual visit and met with the Directo,Anabel Avalos. Facility has 2 infant rooms. Present during the visit is the owner, director, 6 staff and 13 infants. The infant program operates Monday - Friday from 7:30 AM to 5:30 PM

At 8:30 AM LPA toured the facility, indoor and outdoor, LPA kaur observed the following: Facility has 3 infant room. The facility is neat, clean and free of any health and safety hazards. LPA kaur observed infants were playing. Furnishings and equipment appear to be in good condition. LPA Kaur observed infants were having breakfast. Classroom has a diaper changing table within arm’s reach of a sink. There is a refrigerator in the classroom for storing of infant bottles and food for infants ages 0-12 months. All bottles and food are labeled per regulation. The napping area is clean. There are sufficient cribs for infants to nap. There are first aid kits in classroom. The outdoor area was inspected and all toys and equipment appears to be safe and in good condition. There is sufficient cushioning underneath the infant play structure. LPA kaur observed monoxide alarm was missing. Director stated that it fell and she placed the alarm right away. LPA Kaur recommended secure the alarm so it does not fall again. The facility conducts disaster drills and the last drill was conducted on June, 25 2021.

LPA reviewed children and staff files. Facility uses app to sign in and out. Current CPR and first aid for staff was updated. LPA Kaur observed safety sleep log with date and initials. LPA received a copy of the facility roster during today’s visit.

LPA reviewed AB 1207 with the director. Director is aware that as of January 1, 2018 all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

No deficiencies are cited today. Notice of site visit is posted and shall remain posted for next 30 days.


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 report was reviewed and will be email to Director.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2021
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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