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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004986
Report Date: 09/03/2025
Date Signed: 09/03/2025 02:02:03 PM

Document Has Been Signed on 09/03/2025 02:02 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 AVENUEFACILITY NUMBER:
384004986
ADMINISTRATOR/
DIRECTOR:		SYLVIA XUEREBFACILITY TYPE:
860
ADDRESS:1258 20TH AVENUETELEPHONE:
(415) 504-6513
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94122
CAPACITY: 24TOTAL ENROLLED CHILDREN: 13CENSUS: 5DATE:
09/03/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Sylvia XuerebTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On September 3, 2025 at approximately 9:00am, Licensing Program Analysts (LPAs) Catrina Quimbo and Winnie Ly, conducted an unannounced, pre-licensing visit, to ensure that health, safety and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. LPAs met with assistant director, Lourdes "Lola" Petty, explained the purpose of the visit and were granted entry into the facility.

Program is an already licensed preschool program under license 384004791. Applicant, Sylvia Xuereb, requested to change facility's components by adding an infant and toddler component. Due to changing components in facility, a single license has been generated. The existing license number 384004791 will be consolidated to the single license number of 384004986.

At approximately 9:30am, applicant arrived to facility. LPAs continued visit with applicant. Applicant is requesting to be licensed for a total capacity of 24 children: 12 infants (3 months to 24 months) and 12 toddlers (18 months to 36 months). The fire clearance for the component change was received August 21, 2025.

The center will operate Monday through Friday 8:00am to 5:30pm. LPAs toured and measured the on-limits areas and classrooms located at the facility. The facility is a multi-level facility that includes 2 levels. Childcare center operations will operate on the ground level only. The kitchen space on the ground level will a be walk through only for children to access the outdoor area.

The infant component will operate in the infant classroom and the infant napping room. The toddler component will operate in the toddler classroom. The second level of the facility is for staff use only and is made off limits to children. There is a child safety gate making the stairs inaccessible.

Infant Classroom measurements are:
The indoor infant measurements contain a total of 427.78 square feet which will accommodate the request for 12 infants.

Infant Outdoor measurements are:
The outdoor infant measurements contain a total of 180.56 square feet which will not accommodate the request for 12 infants.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 384004986
VISIT DATE: 09/03/2025
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Toddler Classroom measurements are:
The indoor toddler measurements contain a total of 351.58 square feet which will not accommodate the request for 12 toddlers.

Toddler Outdoor measurements are:
The outdoor toddler measurements contain a total of 782.69 square feet, which will not accommodate the request for 12 toddlers.

There are a total of 2 toilets and 2 sinks, available for children's use. These are sufficient to accommodate the requested total capacity of 24 children. There are diaper changing tables in both the infant and toddler classrooms. LPAs observed changing tables are equipped with moisture resistant materials and with sides of the changing table that are at least 3" high. Diapering sinks are not used for meal preparation or dishwashing. Diapering sinks are also within arm's reach to an adult portable sink. Diapers and wipes will be provided by children's families. LPAs observed diapers and wipes to be stored appropriately, labeled with children's individual names. Garbage bins will have tight fitting lids.

The child care center was observed to be safe. Infant and toddler classrooms are physically separate from one another. A comfortable temperature for children is being maintained. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. Tables and chairs were observed to be age appropriate. LPAs observed cleaning solutions and poisons were stored behind child safety locked cabinets, inaccessible to children. LPAs observed drawers in kitchen (pass by only) to have child safety locks installed.

Infants will sleep in the napping room (back room) in cribs. The napping room is physically separate from the infants' activity space. Floor mats will be utilized for toddlers and infants able to climb out of a crib. Toddlers' sheets and blankets will be stored so that they are not touching each other.

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-and-resources/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.

Facility is equipped with a first aid kit, fully charged fire extinguisher, smoke and carbon monoxide detectors, and emergency backpacks. When medications are on site, they will be stored in the toddler classroom in a locked box. Licensing documents are posted in main entrance/lobby area of facility (located in toddler classroom). Children will be signed in and out of program through an electronic application. Isolation area will be in the classroom, separate from other children in care.
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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: 384004986
VISIT DATE: 09/03/2025
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Infant and toddler outdoor areas are physically separate from one another. LPAs observed outdoor areas to be fully fenced and enclosed. There is sufficient outdoor toys and materials in both outdoor areas. Flooring in both outdoor areas includes artificial turf. Per applicant, additional padding is underneath the artificial turf. LPAs did not observe any pools, spas or bodies of water on site.

Drinking water is available with children's individual water bottles that will be labeled with their individual names. Children's water bottles can be refilled on site, through a filtered water pitcher, also refilled through a sink. Program provides a food service that includes morning and afternoon snacks only. Disposable utensils and dishes are utilized. Children's families provide lunch that is stored in children's lunch boxes, stored in their individual cubbies.

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).

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) 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, available at: http://www.ada.gov/childqanda.htm



LPA reviewed with applicant, the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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 athttps://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication
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NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: 384004986
VISIT DATE: 09/03/2025
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Applicant was reminded infant enrolled children and toddler enrolled children must be kept physically separate and cannot co-mingle. Applicant was also reminded toddler option children must have written permission/consent from their authorized representatives to participate in toddler component. Applicant was also reminded infant children must have an infant needs and services plan that must be updated with infants' families, quarterly.

Based on indoor square footage, the facility will be licensed for a maximum capacity of 22 children: 12 infants and 10 toddlers.

The following corrections are needed prior to the issuance of a license:
-Final set up of infant napping room.
-Final set up of all classrooms.
-Submission of updated Application of Childcare Center License (LIC200A) with updated capacity of 22 children.
-Updated fire clearance with updated capacity of 22 children.
-Submission of outdoor rotation waiver (infant outdoor space).
-Approval of outdoor rotation waiver.
-Centralized Application Bureau (CAB) final approval of application.

Applicant, Sylvia Xuereb, understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.

Exit interview conducted and report was reviewed with the applicant, Sylvia Xuereb.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Catrina Quimbo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC809 (FAS) - (06/04)
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