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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004679
Report Date: 07/07/2022
Date Signed: 07/07/2022 01:01:28 PM

Document Has Been Signed on 07/07/2022 01:01 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 KIDZFACILITY NUMBER:
414004679
ADMINISTRATOR:AVALOS, ANABELFACILITY TYPE:
830
ADDRESS:1496 ADOBE DRIVETELEPHONE:
(650) 735-5748
CITY:PACIFICASTATE: CAZIP CODE:
94044
CAPACITY: 18TOTAL ENROLLED CHILDREN: 18CENSUS: DATE:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Anabel AvalosTIME COMPLETED:
01:15 PM
NARRATIVE
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On July 7, 2022 at 10:15 AM, Licensing Program Analyst (LPA) Cowan met with Site Director, Anabel Avalos, for an unannounced annual random inspection. Present today is director, 4 staff, and 13 infants. Staff to child ratio was met on this day. The center operates Monday - Friday 7:00am to 6:00pm.

LPA inspected the infant day care area for health and safety hazards today. The center is clean, orderly and in good repair. There are no pools, spas or other similar bodies of water on site. Per director, there are no firearms or weapons on site. Cleaning supplies and other potentially harmful items are stored inaccessible to the children. All furniture and equipment are clean and in good working condition. The center's furniture and equipment are age appropriate. There is a sufficient quantity of cribs, table/chairs and changing tables meet the capacity. Parents provide bedding for cribs and mats. Bedding is sent home once a week for cleaning by parents while cribs and mates are wiped down and disinfected daily. Bottles and other items provided by the parents are labeled and stored appropriately. Food and formula are provided by parents. Changing tables are within an arm’s reach of a sink. The center has a working carbon monoxide detector. LPA observed infants were supervised by staff in the classrooms and in the napping area. The outdoor play area designated for the infants and toddlers was clean and in good repair. All toys and equipment are in working condition. Areas under slides and other high climbing equipment is adequately cushioned poured rubber and turf.
SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2022
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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Document Has Been Signed on 07/07/2022 01:01 PM - It Cannot Be Edited


Created By: April Cowan On 07/07/2022 at 12:23 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
FACILITY NUMBER: 414004679

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review), the licensee did not comply with the section cited above in that 1 staff did not have a health screenig on file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/22/2022
Plan of Correction
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Director agrees to email LPA LIC 503 Health Screening by the above date. (Celeste Vasquez)
Type B
Section Cited
CCR
101217(a)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on (record review), the licensee did not comply with the section cited above in 1 staff member did not have a file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/22/2022
Plan of Correction
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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 the completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.



>See next page for deficiencies


Exit interview conducted and report was reviewed with site director Anabel Avalos.

This report must be available in the facility for public review. Notice of site visit is to be posted for 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

Director agrees to collect file and send a copy to LPA by above date.(Maylin Ortiz)
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: 07/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022


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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: BUILDING KIDZ
FACILITY NUMBER: 414004679
VISIT DATE: 07/07/2022
NARRATIVE
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At 10:59 AM, Staff files were reviewed. All staff have criminal record clearances on file. Education units are on file for teaching staff. At least one staff member on site has current CPR/First Aid certification. At 11:22 AM, LPA observed that staff did not have Health Screen with TB Clearance on file. At 11:30, LPA observed that another staff member did not have a file. Type B citations are issued for the above deficiencies this day. Children's files were reviewed, and are complete with all required licensing documents.

LPA discussed facility trash cans with director. LPA reviewed Safe Sleep regulations.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Director was reminded that all adults 18 and over, 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 director 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 licensee [facility representative] 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: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 5
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
FACILITY NUMBER: 414004679
VISIT DATE: 07/07/2022
NARRATIVE
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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 the completion certificates on file. LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

>See next page for deficiencies

Exit interview conducted and report was reviewed with site director Anabel Avalos.

This report must be available in the facility for public review. Notice of site visit is to be posted for 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

Copy of this report was reviewed and will be emailed to the director, Anabel Avalos at ANABELA@BUILDINGKIDZ.COM by the close of business on 7/7/22. Confirmation of receipt is required. Signed copy of this report will be stored in the facility file.

SUPERVISORS NAME: Garfield Leung
LICENSING EVALUATOR NAME: April Cowan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022
LIC809 (FAS) - (06/04)
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