434413070-6-18-2024-07-CC-SYIP-D6CSQM-20240618140459

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434413070
Report Date: 06/18/2024
Date Signed: 06/18/2024 02:05:18 PM

Document Has Been Signed on 06/18/2024 02:05 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	BUILDING BLOCK PRESCHOOL		FACILITY NUMBER:	434413070
ADMINISTRATOR:	JUO-CHIH YAO		FACILITY TYPE:	850
ADDRESS:	1073 S. DE ANZA BLVD.		TELEPHONE:	(408) 996-2477
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	20	CENSUS: 16	DATE:	06/18/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Juo-Chih "Ann" Yao		TIME COMPLETED:	02:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Samantha Yip conducted an unannounced annual/random inspection. LPA met with staff, Kamlesh Gupta, and explained the reason for the inspection. Director, Juo-Chih "Ann" Yao, arrived shortly after. Present during today's inspection were 16 children and at least three staff. Facility was within ratio during today's inspection. There is a waiver for outdoor square footage. There is an area to post required postings, such as license, notification of parent's rights, and personal rights. The hours of operation are 7:30AM to 6PM. LPA reviewed sign in/out sheet. LPA observed that parents wrote their title, but did not sign their full legal signature. LPA toured the inside and outside of the center. Disinfectant, cleaning supplies, and other items that could poses a risk to children were inaccessible to children. There are toys and equipment for children. The bathroom was observed to be in functioning conditions. LPA discussed with Licensee that children's blankets cannot touch. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide. Director stated that there is no weapons, such as firearms, stored on the premise. The outside activity area is fenced. Area around play structure has resilient material. Director stated that there is another program that will use the playground area in the afternoon. Director submitted waiver request during today's inspection. There were no bodies of water observed during todays inspection. Shaded rest area is provided through canopy. LPA discussed with Director that any hand sanitizer needs to be inaccessible. -----------------continues on 809 dated 06/18/2024 page 2----------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BUILDING BLOCK PRESCHOOL	FACILITY NUMBER: 434413070
	VISIT DATE: 06/18/2024

NARRATIVE

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----------------continuation of 809 dated 06/18/2024 page 1-----------------------

Facility only provides snacks to children. Snack menu was observed to be posted. All meals are prepared and brought from home. Drinking water is provided through individual water bottles and water filter.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. Director will submit LIC 9275, LIC 9276, and LIC 999 to Licensing.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

A copy of the facility roster was obtained. Six (6) children's files were reviewed during today's inspection. The records reviewed include but not limited to immunization records, admission agreement, and personal's rights. LPA observed that three children did not have personal rights on file.

Three (3) staff files were reviewed during today's inspection. The records reviewed include but not limited to education credit, Mandated Reporter training. There is at least one staff with a valid CPR/1st Aid, which expires on 07/2024.
----------------------continues on 809 dated 06/18/2024 page 3-------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BUILDING BLOCK PRESCHOOL	FACILITY NUMBER: 434413070
	VISIT DATE: 06/18/2024

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----------------continuation of 809 dated 06/18/2024 page 2-------------------

All staff present have cleared criminal record and child abuse index. Licensee was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA discussed with Licensee/Director that she needs to report to Licensing if there is any changes to director, such as director being absent for more than 30. Licensee understands that she will submit paperwork for fully qualified staff is she is absent for more than 30 days.

Licensee will submit the following:

- LIC 9275, LIC 9276, and LIC 999 that shows water outlets tested

- written plan to ensure parents sign their full legal signature
- Mandated Reporter training certificate for S-1

As a result of this inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Licensee/Director Ann Yao. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 06/18/2024 02:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BUILDING BLOCK PRESCHOOL	FACILITY NUMBER: 434413070
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101223(b)(1)

Personal Rights

(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in three out of six persons, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/25/2024
	Plan of Correction
1 2 3 4	By POC 06/25/2024, Licensee will have parents sign LIC 613A and send proof to Licensing.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2024

LIC809 (FAS) - (06/04)

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