434415122-3-24-2022-52-CC-CCHS-CDB3PP-20220408182548

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 434415122
Report Date: 03/24/2022
Date Signed: 03/24/2022 01:05:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/21/2022 and conducted by Evaluator Sabina Dodoo

PUBLIC

COMPLAINT CONTROL NUMBER: 52-CC-20220321085455

FACILITY NAME:	BUILDING KIDZ OF MOUNTAIN VIEW		FACILITY NUMBER:	434415122
ADMINISTRATOR:	RAJESWARI SRIDHARA		FACILITY TYPE:	830
ADDRESS:	250 EAST DANA STREET		TELEPHONE:	(650) 967-8000
CITY:	MOUNTAIN VIEW	STATE: CA	ZIP CODE:	94041
CAPACITY:	42	CENSUS: 14	DATE:	03/24/2022
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Ebun Evien		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Other

INVESTIGATION FINDINGS:

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On 3/24/2022 LPA Sabina Dodoo conducted an Unannouced Random Complaint Inspection at Building Kidz School of Mountain View. LPA Dodoo met with Director Ebun Evien and explained the nature of the visit. LPA toured the infant component of this facility with Director. There were 6 staff members who are all fingerprint cleared and 14 infants.

LPA observed two infant classrooms(Room 5 and Room 7). In room 5 LPA did observe Boppy lounger pillows hanging near the cribs in the napping area. LPA obtained a photo of the boppy loungers with the permission of the Director. At 11:30am after completing a tour of the facility LPA discussed with Director of the recall boppy loungers. Director explained that she is aware that the product is being recalled. Director stated she has washed the covers and had forgotten to move the boppy pillows out of the classroom. She stated she will remove the pillows immediately. LPA observed Director remove the pillows and the facility was in compliance at 11:45am.
Based on LPA's observations, the preponderance of evidence standard has been met, therefore the above allegation of recall product being used at the facility is found to be SUBSTANTIATED. California Code of Regulations 101239(r) (Title 22, Division 12 & Chapter 1), are being cited on the attached LIC 9099D.”)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 52-CC-20220321085455

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BUILDING KIDZ OF MOUNTAIN VIEW	FACILITY NUMBER: 434415122
	VISIT DATE: 03/24/2022

NARRATIVE

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The Licensee acknowledge, that for Type A Deficiency, the licensee shall post the LIC 9099, 9099C & LIC 9099D with Type A deficiency for 30 days and provide copies of this licensing report to parents/ guardians of children in care at the facility and to parents/ guardians of children newly enrolled at the facility during the next 12 months.

The LIC 9224 must be signed by parents/ guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the Director. A copy of the LIC 9224 was given to Director at time of this inspection.
An exit interview was conducted. Appeal rights were given and explained to the Director Ebun Evien. Notice of Site Visit was posted.

SUPERVISOR'S NAME: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC9099 (FAS) - (06/04)

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Control Number 52-CC-20220321085455

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BUILDING KIDZ OF MOUNTAIN VIEW	FACILITY NUMBER: 434415122
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/24/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/28/2022 Section Cited CCR 101239(r)	1 2 3 4 5 6 7	101239 (r) Fixtures, Furniture, Equipment and Supplies: Fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission shall not be used or on the facility’s premises. This requirement is not being met as evidenced by:	1 2 3 4 5 6 7	LPA observed Director remove the boppy lounger pillows out of the classroom area. Director must submit a written letter to Licensing Department stating she acknowledge the policy & procedures about banned and/or recall product in a licensed day-care facility.
	8 9 10 11 12 13 14	Based on observation LPA observed four recalled boppy lounger pillows in the infant classroom near the cribs. This poses an immediate Health, Safety, and Personal Rights to children in care.	8 9 10 11 12 13 14	The letter should be received by email or hard copy within 24 hours email or two days by mail to CCLD – Child Care Program, 1515 Clay Street, Ste. 1102, flr 11th Oakland , Ca 94612; Attention to LPA Sabina Dodoo , facility #434415122
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Chandra Charles	TELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina Dodoo	TELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC9099 (FAS) - (06/04)

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