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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416421
Report Date: 03/29/2023
Date Signed: 03/29/2023 03:30:31 PM

Document Has Been Signed on 03/29/2023 03:30 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
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: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 16DATE:
03/29/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Manali DoshiTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Ashley Lopez and Samantha Yip conducted an unannounced Case Management- Lead Testing/Exceedance inspection. LPA met with director, Manali Doshi, and explained the reason for the inspection. The purpose of this inspection is facility had one sink with a lead exceedance of 5.5ppb.

During today's inspection, LPA inspected the sink that had the exceedance, Sink A. Sink is located in the infant building. Sink A had a result of 61 ppb. Facility has seized use of sink for drinking water since 11/23/22, sink will be used only for hand-washing. Facility is collecting water from sink in bathroom to use for Brita filter.

A copy of the LIC 999, LIC 9276, and LIC 9275 was emailed to Licensing on 3/22/23.

As a results of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Manali Doshi. A notice of site visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
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.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/29/2023 03:30 PM - It Cannot Be Edited


Created By: Ashley Lopez On 03/29/2023 at 01:08 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
, 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)
Request Denied
Type B
04/28/2023
Section Cited

101799.3(b)(1)

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Lead Testing Written Directives. a result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.  This requirement is not met as evidence by:
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Facility seized use of sink for drinking water.
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Sink A had a result of 61 ppb.This posed 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.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Ashley Lopez
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


LIC809 (FAS) - (06/04)
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