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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002749
Report Date: 08/12/2019
Date Signed: 08/14/2019 11:13:55 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BUILDING KIDZ OF SSF, INC.(PRESCHOOL)FACILITY NUMBER:
414002749
ADMINISTRATOR:JACQUELINE GALDAMEZFACILITY TYPE:
850
ADDRESS:600 GRAND AVENUETELEPHONE:
(650) 837-9348
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY:54CENSUS: 25DATE:
08/12/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jacqueline GaldamezTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Manager (LPM) Malig and Licensing Program Analyst Ly conduct an unannounced inspection to this facility and met with the Director Jacqueline Galdamez. Present at the preschool areas are 25 children and 4 staff. Purpose of the inspection was explained. LPM and LPA toured the facility. During the inspection, LPM and LPA found a staff member does not have criminal record clearance.


It was observed that S1 was working in the classroom without Criminal Record Clearance.

CIVIL PENALTIES OF $100 ASSESSED FOR CRIMINAL RECORD CLEARANCE.

Deficiencies cited today under California Code of Regulations, Title 22, follows on LIC 809D.
Appeal Rights given.
Report reviewed and discussed with Anna Galdamez
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BUILDING KIDZ OF SSF, INC.(PRESCHOOL)
FACILITY NUMBER: 414002749
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/12/2019
Section Cited
CCR
101170(e)(1)
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Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. Based on review of staff files and observation, S1 was present in the classroom and does not have a Criminal Record Clearance. Licensee failed to ensure staff have criminal record clearance prior to working in the facility, which poses an immediate health and safety risk to children in care.
CIVIL PENALTIES OF $100 ASSESSED.


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During the inspection facility owner Anna Galdamez faxed LIC 9182 criminal record clearnance transfer request to CCLD.

Facility Owner is advised to check with the office for clearance prior to having staff present at site.
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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: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Winnie LyTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019
LIC809 (FAS) - (06/04)
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