414004236-7-11-2019-05-CC-GLEG-BFC2KD-20190823172746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 414004236
Report Date: 07/11/2019
Date Signed: 07/11/2019 01:13:24 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/12/2019 and conducted by Evaluator Gagandeep Singh

PUBLIC

COMPLAINT CONTROL NUMBER: 05-CC-20190612163957

FACILITY NAME:	BUILDING KIDZ (PS)		FACILITY NUMBER:	414004236
ADMINISTRATOR:	NESHEIWAT, SAMANTHA		FACILITY TYPE:	850
ADDRESS:	39 E. 39TH AVENUE		TELEPHONE:	(650) 212-5439
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	70	CENSUS: 44	DATE:	07/11/2019
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Samantha Nesheiwat & Jennifer Nushwat		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulting in child being injured by another child.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Singh met with director, Samantha Nesheiwat, and site director, Jennifer Nushwat, for the inspection of the complaint alleging the above allegation. Purpose of the inspection was explained.

During the inspection, LPA inspected the facility with site director and interviewed the director and site director. During the inspection, LPA observed the facility has sufficient amount of staff present at the facility. LPA observed the staff was engaged with children in different activities.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alma Malig	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Gagandeep Singh	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 2