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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004637
Report Date: 11/08/2023
Date Signed: 11/08/2023 12:58:18 PM

Document Has Been Signed on 11/08/2023 12:58 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:BUILDING KIDZ SCHOOLFACILITY NUMBER:
414004637
ADMINISTRATOR:FRIEDLIN, LINDAFACILITY TYPE:
850
ADDRESS:1633 LAUREL STREETTELEPHONE:
(650) 718-6800
CITY:SAN CARLOSSTATE: CAZIP CODE:
94070
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 40DATE:
11/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:48 AM
MET WITH:Komal RajputTIME COMPLETED:
01:15 PM
NARRATIVE
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On November 8,2023, Licensing Program Analyst (LPA) Maria Olguin-Leon conducted an unannounced visit to close a complaint investigation in conjunction with a case management inspection of children’s files. LPA reviewed children’s files for LIC9224’s Acknowledgement of receipt of reports. LPA met with Director Komal Rajput and explained purpose of inspection.

LPA and Director toured facility for health and safety hazards. LPA requested to review newly enrolled children's files. Upon review of newly enrolled children’s files, one child was missing documentation of LIC9224 in child’s folder. A type A citation was issued on August 23, 2023, and facility was advised to provide report to all enrolled parents and to all newly enrolled families for the next 12 months. LPA asked Director for LIC9224 for newly enrolled child and Director was unable to locate. LPA advised Director to move parent licensing board to main entrance where it is visible to all families.

A type B citation was issued today under California Code of Regulations, Title 22, Division 12, which follows on LIC 809D.

This report and exit interview were conducted and appeal rights was given to Director, Komal Rajput. This report must be available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days.
Marie Rodriguez
Maria Olguin-Leon
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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Document Has Been Signed on 11/08/2023 12:58 PM - It Cannot Be Edited


Created By: Maria Olguin-Leon On 11/08/2023 at 11:49 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BUILDING KIDZ SCHOOL
FACILITY NUMBER: 414004637

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
11/15/2023
Section Cited

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A licensed child day care facility shall provide to the parents or guardians of each child receiving services in the facility copies of any licensing report that documents any Type A citation that represents an immediate risk to the health, safety, or personal rights of children in care.

This requirement has not been met as evidenced by:
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Based on file reviews conducted today, facility failed to meet this requirement by not having newly enrolled children representatives complete and sign LIC9224 Acknowledgement of Receipt of Licensing Reports as required for a type A violation, which is an immediate risk to the health and safety of children in care.

This poses a potential health and safety risk to the children in care.

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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:Marie Rodriguez
LICENSING EVALUATOR NAME:Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023


LIC809 (FAS) - (06/04)
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