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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414004237
Report Date: 07/07/2025
Date Signed: 07/07/2025 04:09:24 PM

Document Has Been Signed on 07/07/2025 04:09 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 (INF)FACILITY NUMBER:
414004237
ADMINISTRATOR/
DIRECTOR:		NESHEIWAT, SAMANTHAFACILITY TYPE:
830
ADDRESS:39 E. 39TH AVENUETELEPHONE:
(650) 212-5439
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: 12DATE:
07/07/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Samantha NesheiwatTIME VISIT/
INSPECTION COMPLETED:
04:20 PM
NARRATIVE
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On 7/7/2025, at approximately 10:00AM, Licensing Program Analysts (LPAs) Jonathan Tse and Katie Krenn conducted an unannounced annual visit at the facility. LPAs met with Director, Samantha Nesheiwat (D1), and explained the purpose of the visit. Present during the visit was D1, Executive Director Jennifer Massis (E1), four staff members, and 12 infants. The facility is operating within staffing and ratio requirements on this day. The facility’s operating hours are from 7:00AM to 6:00PM, Monday to Friday.

This facility is a combination center, with a preschool license (414004236), located on the premises of Trinity Baptist Church.

LPAs and D1 inspected the facility for any health or safety hazards. LPAs observed there to be a fully charged 3A40BC fire extinguisher present. There is a fire alarm system running throughout the facility. LPAs observed a carbon monoxide detector to be present. Emergency exits are clearly marked and visible. Evacuation routes are posted and accessible for review. LPAs advised that electrical outlets be maintained in good condition and covered. D1 stated that they understood. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care.

There are age-appropriate toys and learning materials present. Furniture is age-appropriate and free of rough or sharp edges. LPAs observed that a rug exuded an odor while conducting a walk through of the infant room. Infant napping spaces are kept separate from infant activity spaces.

LPAs observed that there were three baby bouncers present in the infant napping room. All baby bouncers and the rug were removed from the facility during the visit. LPAs observed an infant to be asleep in an infant swing upon entry to the room. The infant woke up and was attended to by an infant teacher. LPAs advised E1 that a deficiency would be cited for not immediately moving a sleeping infant into a crib.
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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2025
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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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 (INF)
FACILITY NUMBER: 414004237
VISIT DATE: 07/07/2025
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There is a diaper changing station that is within hands reach of a handwashing sink. LPAs observed crib mattresses to not be fitted with tight-fitting sheets. LPAs advised E1 that mattresses must be fitted with tight-fitting sheets and that a deficiency would be cited during today’s visit. E1 stated that they understood.

LPAs observed the surface of the outdoor play area to be free of debris and other loose articles. The surface of the outdoor play area has padding that is covered with a plastic layer. LPAs observed there to be holes and tears in the plastic layer. E1 stated that the outdoor play area is in the process of being renovated. LPAs informed E1 that a deficiency would be cited during today’s visit. E1 stated that they understood. LPAs observed there to be a trampoline intended for use by children ages 3 and up. The facility removed the trampoline during the visit. LPAs advised that manufacturers instructions be reviewed for all toys and equipment. The outdoor play area is enclosed by a fence that is at least four feet high.

There are no swimming pools or other similar bodies of water present in the facility. There are no firearms or weapons present.

LPAs reviewed four staff files and six children’s files. All staff members present do not have First Aid/CPR training from the American Red Cross, American Heart Association, or an EMSA approved training program. Staff qualifications are available for review.

Children’s files were observed to be complete. Infant sleeping logs are not maintained at the facility. LPAs advised that infant sleep checks must be conducted and logged. A sample sleep log was provided during the visit.

All required postings were observed to be posted and accessible for review in the main entrance of the facility. Children are signed in and out of the facility via the BuildingKidz app. The facility last conducted an emergency drill on 7/7/2025. Drills are properly logged and documented.




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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
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 (INF)
FACILITY NUMBER: 414004237
VISIT DATE: 07/07/2025
NARRATIVE
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To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Facility representative 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.

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. 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).

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA discussed the safe sleep regulations with facility representative 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 licensee [or facility representative] 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.


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NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
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 (INF)
FACILITY NUMBER: 414004237
VISIT DATE: 07/07/2025
NARRATIVE
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see PIN 22-02-CCP. 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/.

Facility representative was informed of the MyChildCarePlan.org website; 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.

See LIC809-D for deficiencies cited today regarding First Aid/CPR, condition of the outdoor play space, mattresses with ill-fitting sheets, moving sleeping infants to a crib, and maintaining infant sleep logs. See LIC9102-TV for technical violations issued today regarding infant equipment and materials.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Samantha Nesheiwat.
NAME OF LICENSING PROGRAM MANAGER: Ali Zebila
NAME OF LICENSING PROGRAM ANALYST: Jonathan Tse
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2025 04:09 PM - It Cannot Be Edited


Created By: Jonathan Tse On 07/07/2025 at 03:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BUILDING KIDZ (INF)
FACILITY NUMBER: 414004237

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101439.1(b)(1)
Infant Care Center Sleeping Equipment
(b) A crib or portable -crib meeting United States Consumer Product Safety Commission safety standards shall be provided for each infant who is unable to climb out of a crib. (1) Mattresses shall be firm and covered with a fitted sheet that is appropriate to the mattress size, fits tightly on the mattress, and overlaps the underside of the mattress so it cannot be dislodged.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by having sheets which are not tightly fitted onto crib mattresses, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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Licensee shall submit proof of mattress equipped with tight-fitting sheets via email by set due date of 7/28/2025.
Type B
Section Cited
CCR
101238.2(d)(1)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (1) In a safe condition for the activities planned.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/07/2025
Plan of Correction
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Licensee shall submit a plan or timeline of planned renovations to LPA via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2025 04:09 PM - It Cannot Be Edited


Created By: Jonathan Tse On 07/07/2025 at 03:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BUILDING KIDZ (INF)
FACILITY NUMBER: 414004237

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101430(a)(3)(E)
Infant Care Activities
(E) If an infant falls asleep before being placed in a crib, staff shall move the infant to a crib as soon as possible.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above by not moving a sleeping infant into a crib from an infant swing, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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The infant was removed from the swing during the visit. Licensee shall conduct a training regarding safe sleep regulations and submit a meeting memo that is signed by all staff present to LPA via email.
Type B
Section Cited
CCR
101216(f)
Personnel Requirements
(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in four out of four staff files reviewed, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2025
Plan of Correction
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Licensee shall register at least one staff member for a Pediatric First Aid/CPR class and submit proof of registration to LPA via email. Training must completed with the American Red Cross, American Heart Association, or an EMSA approved training program.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2025


LIC809 (FAS) - (06/04)
Page: 7 of 11
Document Has Been Signed on 07/07/2025 04:09 PM - It Cannot Be Edited


Created By: Jonathan Tse On 07/07/2025 at 03:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: BUILDING KIDZ (INF)
FACILITY NUMBER: 414004237

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101429(a)(2)(C)
Responsibility for Providing Care and Supervision for Infants
(C) Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on interview and record review, the licensee did not comply with the section cited above by not maintaining infant sleep logs, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2025
Plan of Correction
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Licensee shall submit three days worth of infant sleep logs for three children to LPA by set due date of 7/21/2025.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ali Zebila
NAME OF LICENSING PROGRAM MANAGER:
Jonathan Tse
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2025


LIC809 (FAS) - (06/04)
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