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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093623367
Report Date: 12/28/2021
Date Signed: 12/28/2021 02:53:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:BUILDING KIDZ EL DORADO HILLSFACILITY NUMBER:
093623367
ADMINISTRATOR:SANTOS, ANNIEFACILITY TYPE:
850
ADDRESS:5041 ROBERT J MATTHEWS PRKY200TELEPHONE:
(916) 358-5276
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:25CENSUS: 0DATE:
12/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cindi BuccolaTIME COMPLETED:
03:00 PM
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Application Specialist (AS) Alecia Sifuentes, Application Specialist (AS) Mai Lor, and Licensing Program Analyst (LPA) Arianna Manabat met with Licensee Cindi Buccola for the purpose of an announced pre-licensing change of location inspection. Licensee request to increase the preschool capacity from 25 to 48 preschool children ages two to entry into first grade. The facility's hours of operation are Monday through Friday from 7:00 AM to 6:00 PM. AS Lor received the fire clearance on 12/16/21.

AS and LPA conducted a health and safety inspection in all areas accessible to preschool children. There are three existing preschool classrooms. The Licensee is adding one additional preschool classroom. AS Lor, AS Sifuentes, and LPA Manabat remeasured the classrooms. The total classroom space contains a total of 2385.264 square feet, which will accommodate the requested capacity of 48 preschool children. There are three toilets and five sinks available to children, and a separate staff restroom is available. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office and will use the staff restroom, if necessary.

INDOOR ACTIVITY SPACE:

AS Lor, Sifuentes and LPA Manabat observed sufficient number of furniture, toys, mats, cubbies, and play equipment in the classrooms. AS Lor, AS Sifuentes and LPA Manabat did not observed a functional carbon monoxide detector. AS and LPA observed disinfectants and medications are inaccessible and appropriately stored. AS and LPA observed a electronic sign-in/sign-out system. The facility will provide morning and afternoon snacks. Parents will be responsible for lunch.




(Report continues on subsequent LIC 809)
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: BUILDING KIDZ EL DORADO HILLS
FACILITY NUMBER: 093623367
VISIT DATE: 12/28/2021
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OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. AS Lor observed sufficient amount of equipment and toys. AS Lor observed that the gate and the play ground flooring is being put in during this inspection. Licensee stated the playground should be completed by today. There are no bodies of water on the premises. There are shaded areas supplied by trees. Facility will also be using part of the indoor area as an indoor gross motor area.

AS Lor, AS Sifuentes, and LPA Manabat measured the preschool outdoor play yard. The outdoor preschool yard contains a total of 1518.176 square feet. AS Lor used previous indoor gross motor area measurement from report dated 12/12/2019. The indoor gross motor area measured 712.85 square feet. Licensee will submit an insufficient waiver request with a rotating schedule with no more than 20 preschool children outdoor and no more than 9 preschool children in the indoor gross motor area. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

AS emailed LIC311A, Effects of Lead Exposure brochure and Provider Notice Information (PIN) 21-21 (Release of the Written Directives for Lead Testing of Water in Licensed Child Care Centers per AB 2370), and immunization card. AS and LPA reviewed lead testing requirement and COVID-19 technical assistance with the applicant.

This facility plans to provide Incidental Medical Services - IMS. For IMS information, see Evaluator Manuel - Regulation Interpretations and Procedures for Child Care Centers Section 101173 and 101226. A 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.

Licensee 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.

(Report continues on subsequent LIC 809).
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: BUILDING KIDZ EL DORADO HILLS
FACILITY NUMBER: 093623367
VISIT DATE: 12/28/2021
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Licensee was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request.

Prior to issuing a license, the following items must be corrected:

1. Submit revised parent and employee handbook
2. Submit revised outdoor facility sketch to include the new playground
3. Submit pending documents for director
4. Submit revised job descriptions
5. Submit revised admission agreement
6. Submit insufficient outdoor waiver
7. Submit photo of completed preschool outdoor play yard
8. Pending Licensing Program Manager Maria Mayorga's final review
9. Submit photo of Carbon Monoxide detector

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Cindi Buccola..
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Mai LorTELEPHONE: (916) 491-0182
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3