384004823-12-27-2023-05-CC-CQUO-CYWSG7-20231227125127

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384004823
Report Date: 12/27/2023
Date Signed: 12/27/2023 12:51:33 PM

Document Has Been Signed on 12/27/2023 12:51 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:	384004823
ADMINISTRATOR:	XUEREB, SYLVIA		FACILITY TYPE:	850
ADDRESS:	1214 20TH AVENUE		TELEPHONE:	(415) 494-1305
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94122
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 7	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, Sylvia 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 (384004223). The applicant is requesting a preschool license with a toddler option component. Per initial application, applicant requested a capacity of 24 children (ages 18 months to 2 years old). Applicant stated they will submit an updated application to reflect updated capacity of 20 children: 8 preschool age (2 years to entry into first grade) and 12 toddler option component (18 months to 36 months). LPA reminded applicant toddler option component children must be kept physically separate from preschool age children. LPA reminded applicant children participating in toddler option component must have written authorization from children's authorized representatives. The program will operate Monday through Friday 7:30am to 5:30pm. The designated director will be Sylvia Xuereb. Facility is a single level facility that includes a lobby area, preschool area, toddler option area, children's restroom, adult restroom, kitchen and outdoor area. The facility was inspected today, indoors and outdoors, for health and safety hazards and measured to calculate 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: The preschool program will operate in the front portion of the classroom. The back portion of the classroom will be for toddler option component children. Children will be separated by a "pony" wall . Total indoor square footage equals 703 sq. ft. allowing for a capacity of 20 children. (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: 384004823
	VISIT DATE: 12/27/2023

NARRATIVE

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LPA observed facility to be well ventilated with appropriate temperature. Floor was observed to be clean. Facility is equipped with a variety of toys, materials and furniture that were age appropriate and in good condition. Storage for children's belongings are located in the lobby area of facility.

Applicant plans to store poisons, cleaning supplies and hazardous materials in facility's high shelves, inaccessible to children. Medications with children’s individual names and required documentation will be stored in facility's high shelves. Applicant stated they are aware medications must be made inaccessible to children.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) tollfree 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, available at: http://www.ada.gov/childqanda.htm.

Applicant plans to provide napping children with cots. There are cribs in the facility if needed. Children's families are to provide blankets and sheets. Per applicant, blankets and sheets will be sent home weekly or as needed. Applicant stated they are aware children's sheets cannot touch each other.

Applicant plans for isolation area to be in the facility office, separate from other children in care. There is an adult restroom for staff use only. Program's discipline policy will be redirection. Children's restroom includes 2 toilets and 2 sinks. Total allowable capacity of toilets is 30 children. Total allowable capacity of sinks is 30 children. LPA observed children's restroom to be in working condition. There is a diaper changing table in the facility that is within arm's reach to a sink.

Applicant plans to provide a food service that includes morning snack and afternoon snack only. Children's families are to provide lunch. Food will be prepared in the kitchen that will be for staff use only. There is a child safety gate, that makes kitchen inaccessible.

Drinking water will be made available for children through children's individual water bottles. Children's individual water bottles can be refilled on site through a filtered water pitcher.
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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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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: 384004823
	VISIT DATE: 12/27/2023

NARRATIVE

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The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Applicant was reminded all child care centers operating in a building constructed before 2010 must test their water for lead contamination. For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Outdoor: There is an outdoor that children have exclusive use of. The outdoor area measures 1,319.5 sq ft. allowing for a total of 17 children. Applicant plans to submit a waiver request. Outdoor area includes a variety of outdoor toys and equipment. There is a sandbox in the area that was observed to be properly covered. LPA did not observe any bodies of water on site. Sufficient shade is provided by a gazebo.

Applicant stated they are aware emergency disaster drills are to be documented when conducted. LPA reviewed with applicant, the LIC311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education
website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/ subscribe and select the Child Care option to receive email communication.
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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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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: 384004823
	VISIT DATE: 12/27/2023

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LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA will approve a provisional license for 20 preschool children (8 preschool age and 12 toddler option 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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