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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 434416421
Report Date: 03/29/2023
Date Signed: 03/29/2023 02:49:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2023 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230320103714
FACILITY NAME:BUILDING KIDZ SCHOOLFACILITY NUMBER:
434416421
ADMINISTRATOR:MANALI AMAR DOSHIFACILITY TYPE:
830
ADDRESS:4115 JACKSOL DRIVETELEPHONE:
(408) 559-1003
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:24CENSUS: 16DATE:
03/29/2023
UNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Manali DoshiTIME COMPLETED:
02:55 PM
ALLEGATION(S):
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Failed to report to licensing
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Samantha Yip and Ashley Lopez conducted an unannounced complaint investigation for the above allegation. This allegation was initiated on the complaint received on 03/10/2023. LPA met with Licensee/Director Manali Doshi and explained the reason for the inspection.

During today's investigation, LPAs interviewed four staff. Based on the information obtained, the above allegation is found to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of the evidence standard has been met. Based on interviews, there was an incident where a child was left unsupervised outside. The child did not sustain any injuries from the incident. The incident was not reported to Licensing. Licensee stated that she was made aware of the incident and conducted her own investigation of the incident. Licensee stated that she did not have information that alluded that the incident occurred.

As a result of this inspection, a type B citation was issued. Exit interview conducted and report was reviewed with Licensee/Director Manali Doshi. A notice of site visit has been issued and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 07-CC-20230320103714
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BUILDING KIDZ SCHOOL
FACILITY NUMBER: 434416421
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/05/2023
Section Cited
CCR
101212(d)(1)(C)
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Reporting Requirements. Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement is not met as evidenced by:
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By POC 04/05/2022, Licensee stated that she will submit written plan that she understands reporting requirements to Licensing.
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Based on interviews and record reviews, there was an incident where a child was left unsupervised outside. Incident was not reported to Licensing, which poses a potential health and safety 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.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/20/2023 and conducted by Evaluator Samantha Yip
PUBLIC
COMPLAINT CONTROL NUMBER: 07-CC-20230320103714

FACILITY NAME:BUILDING KIDZ SCHOOLFACILITY NUMBER:
434416421
ADMINISTRATOR:MANALI AMAR DOSHIFACILITY TYPE:
830
ADDRESS:4115 JACKSOL DRIVETELEPHONE:
(408) 559-1003
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:24CENSUS: 16DATE:
03/29/2023
UNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Manali DoshiTIME COMPLETED:
02:55 PM
ALLEGATION(S):
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2
3
4
5
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7
8
9
Director failed to fulfill duties
INVESTIGATION FINDINGS:
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9
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11
12
13
Licensing Program Analysts (LPAs) Samantha Yip and Ashley Lopez conducted an unannounced complaint investigation for the above allegation. This allegation was initiated on the complaint received on 03/10/2023. LPA met with Licensee/Director Manali Doshi and explained the reason for the inspection.

During today's inspection, LPA interviewed staff and reviewed director's job description/duties. Based on the information obtain, the above allegation is found to be UNSUBSTANTIATED, meaning although, the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiencies were issued. Exit interview conducted and report was reviewed with Director Manali Doshi. A notice of site visit was issued and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3