384004791-12-27-2023-05-CC-CQUO-CYWSGJ-20231227125200

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004791
Report Date: 12/27/2023
Date Signed: 12/27/2023 12:52:06 PM

Document Has Been Signed on 12/27/2023 12:52 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 ON 20TH AVENUE		FACILITY NUMBER:	384004791
ADMINISTRATOR:	XUEREB, SYLVIA		FACILITY TYPE:	850
ADDRESS:	1258 20TH AVENUE		TELEPHONE:	(415) 494-1305
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY: 50	TOTAL ENROLLED CHILDREN: 9	CENSUS: 0	DATE:	12/27/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Slyvia Xuereb		TIME COMPLETED:	01:15 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	On December 27, 2023 at approximately 9:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a scheduled, pre-licensing inspection. LPA met with applicant, Slyvia Xuereb, and explained the purpose of the visit. No children were present during LPA's visit. This is a change of ownership application. Facility is currently licensed (384003039). The applicant is requesting a preschool license for a capacity of 30 preschool children (ages 2 years to entry into first grade). The program will operate Monday through Friday 7:30am to 5:30pm. The designated director will be Michelle Palacio. Facility is a multi-level facility that includes a lobby area, 3 classrooms, kitchen (walk through only), office space, lounge area (staff use), and outdoor area. The facility was re-measured today, indoors and outdoors, to verify capacity. Children will be signed into and out of program by authorized representatives' electronic signatures through an electronic application. Applicant was reminded sign in/out sheets must be made readily available for review. Indoors: There are 3 classrooms for the preschool use that are located on the ground level of the facility. Classroom #1 (3-4 year olds: front room w/ bathroom) was measured for 374.83 sq. ft. allowing for a capacity of 10 children. Classroom #2 (4-5 year olds: front room with stairs) was measured for 433.23 sq. ft. allowing for a capacity of 12 children. Classroom #3 (2-3 year olds: back room) was measured for 215.83 sq. ft. allowing for a capacity of 6 children. Total indoor square footage equals 1,023.89 sq. ft. allowing for a capacity of 29 children. The second level of the facility includes an office space, lounge area and adult restroom. Second level of the facility will for staff use only and is made off limits to children with a child safety gate. (Continue Report on Page 2...)

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 ON 20TH AVENUE	FACILITY NUMBER: 384004791
	VISIT DATE: 12/27/2023

NARRATIVE

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Children's restroom is located in Classroom #1 with 2 toilets and 2 sinks. There is an additional children's restroom in Classroom #3 that children will have access to when needed. Per applicant, children's restroom in Classroom #3 will be for children's use when children are in the outdoor area. Total allowable capacity of toilets is 45 children. Total allowable capacity of sinks is 45 children. Toilets and sinks were observed to be in proper working condition, equipped with appropriate sanitation products.

Outdoor: The outdoor area measures 1,032 sq ft. allowing for a total of 13 children. Applicant plans to submit a waiver request. Entire outdoor area is fully enclosed and fenced. There is a fire escape area in the outdoor area that is also fully enclosed and fenced. Outdoor area includes a variety of toys and equipment. There is a climbing/hanging structure that has resilient padding underneath. Sufficient shade is provided by multiple gazebos.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Maximum capacity facility can be licensed for is 26 preschool children based on previous licensee's capacity. LPA will approve a provisional license for 26 preschool children when fire clearance is received.

LPA will approve a regular license when entire application and pending documentation has been reviewed and accepted.

Exit interview conducted and report was reviewed with the applicant, Sylvia Xuereb.

SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC809 (FAS) - (06/04)

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