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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700740
Report Date: 02/01/2023
Date Signed: 02/01/2023 04:39:50 PM

Document Has Been Signed on 02/01/2023 04:39 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
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BUILDING KIDZ SCHOOLFACILITY NUMBER:
435700740
ADMINISTRATOR:ALVAREZ, CYNTHIAFACILITY TYPE:
850
ADDRESS:569 SAN ANTONIO ROADTELEPHONE:
(650) 966-6400
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 21DATE:
02/01/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Dibjot Gill TIME COMPLETED:
04:55 PM
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On 2/1//2023 at 2:45PM, Licensing Program Analysts (LPA) Michael Mathew and Andrew Elliot conducted an unannounced Case management visit. LPA conducted the Covid-19 screening questions prior to entering the facility. LPA met with owner Dibjot Gill for deficiency that were issued on 1/19/2023 during the annual inspection.

LPA observed 21 children and 4 staff at the time of the inspection. Owner DIbjot Gill was able to provide LPA both staff and children's file for LPA to review. LPA observed children's files to be complete and current. ). LPA observed staff files to be complete and current. LPA verified SB792 Child Care Adult Immunization and Tuberculosis requirements.


LPA Michael cleared deficiency and provided licensees with the Plan of Correction (POC) letter.

No deficiencies were sites in todays visit

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with owner Dibjot Gill

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
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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