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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623348
Report Date: 12/12/2019
Date Signed: 12/12/2019 02:17:16 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 - ROSEVILLE WESTFACILITY NUMBER:
313623348
ADMINISTRATOR:BROWN, ZOEFACILITY TYPE:
830
ADDRESS:945 ROSEVILLE PARKWAYTELEPHONE:
(925) 918-1105
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:16CENSUS: 0DATE:
12/12/2019
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Cindi BuccolaTIME COMPLETED:
02:45 PM
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Application Specialist (AS) Seychelle De Luca and Licensing Program Analyst (LPA) Jan Hoshida met with Applicant Cindi Buccola for the purpose of an announced prelicensing change of ownership inspection. Applicant requests an infant license to serve 16 infant children from birth to two years of age. The program will operate Monday through Friday from 7:00 AM to 6:00 PM. The fire clearance was granted on 12/10/19.

Applicant acknowledges that the following documents must be posted at all times: License, Emergency Disaster Plan, Personal Rights, Parents' Rights Poster, menus, and daily schedule. AS and LPA discussed the forms that must be in each child's and each staff member's file and AS provided LIC311A, Safe Sleep in Child Care, Effects of Lead Exposure brochure, Healthy Schools Act survey, and new immunization card. Applicant stated the Needs and Services plans will be kept in the classrooms. Parents will provide formula, breast milk, and baby food for their children.

INDOOR ACTIVITY SPACE:
There are two infant classrooms: young infant classroom and one year old classroom (located next to the office area). AS and LPA observed a sufficient amount of equipment, toys, napping mats, and six cribs. Applicant acknowledges there will be a maximum of six infants under 12 months old, due to available cribs. There is a first aid kit in each of the classrooms. Medications will be stored in the office area in a locked box. AS and LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. AS and LPA observed a changing pad within arm's reach of a sink in the young infant classroom. Applicant provided proof a portable sink and changing table have been ordered for the one year old classroom. Applicant provided proof booster seat with trays have been ordered. Applicant stated the facility will have a water pitcher and cups available for infants in both classrooms AS observed a functional carbon monoxide detector in the kitchen. AS and LPA observed an electronic sign-in/sign-out system.

Report continues on 809-C.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De LucaTELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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 - ROSEVILLE WEST
FACILITY NUMBER: 313623348
VISIT DATE: 12/12/2019
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AS measured three classrooms. The total classroom space contains a total of 1142.475 square feet, which will accommodate Applicant' request for 16 infant children. There are four toilets and five sinks for the children, and a separate private restroom for the staff. Applicant provided proof a potty chair has been purchased to meet the toilet requirement. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one preschool outdoor area on the property. The outdoor play area is fenced with a wrought iron fence that is at least four feet tall. AS and LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. There are shaded areas supplied by trees, overhangs, and canopies.

AS and LPA measured the outdoor activity space. The outdoor play area contains a total of 2403.489 square feet, which accommodates Applicant's request for 48 preschool children. Applicant provided a waiver request to use a rotating schedule where no more than 32 children will be outside at one time and a request for preschool children and infants to share the outdoor space. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The facility's Plan of Operation is located in the facility file. Incidental Medical Services and a Plan of Operation is located in the facility file. 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.

Report continues on 809-C.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De LucaTELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
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 - ROSEVILLE WEST
FACILITY NUMBER: 313623348
VISIT DATE: 12/12/2019
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AS and LPA discussed the following: 100% supervision is required at all times; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. AS and LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

This facility evaluation report was reviewed and discussed with Applicant. Applicant was encouraged to the visit the Department's website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, regulations and legislation pertaining to child care centers.

The following items are required before a license will be issued:

1. LPM Keven Peters' final file review.

SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Seychelle De LucaTELEPHONE: (916) 217-4316
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3