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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 414004756
Report Date: 11/03/2023
Date Signed: 11/03/2023 05:12:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/29/2023 and conducted by Evaluator Maria Olguin-Leon
COMPLAINT CONTROL NUMBER: 05-CC-20230829151733
FACILITY NAME:BUILDING KIDZ OF REDWOOD CITY ROOSEVELT AVE.FACILITY NUMBER:
414004756
ADMINISTRATOR:STEPHANIE LOPEZFACILITY TYPE:
830
ADDRESS:909 ROOSEVELT AVE.TELEPHONE:
(650) 482-2407
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:16CENSUS: 12DATE:
11/03/2023
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Eman IsbeihTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Day care child was bitten by other day care child while in care due to inadequate staff supervision.
INVESTIGATION FINDINGS:
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On November 3, 2023, Licensing Program Analyst (LPA) Maria Olguin-Leon, conducted an unannounced visit to close the complaint investigation into the above allegation and met with Director Eman Isbeih. Present during today’s visit were Director, 5 staff and 12 infants.

Based on investigation and information gathered through interviews conducted and physical tours of the facility, the allegation Day care child was bitten by other day care child while in care due to inadequate staff supervision, the preponderance of evidence standards has been met, therefore, the above allegation is found to be SUBSTANTIATED. A Type “B” violation was issued today in accordance to the California Code of Regulations, Title 22, Division 12, Chapter 1, citation was being cited on the attached LIC9099D

This report and exit interview were conducted and appeal rights was given to Director, Eman Isbeih. Notice of Site Visit shall remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 05-CC-20230829151733
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 OF REDWOOD CITY ROOSEVELT AVE.
FACILITY NUMBER: 414004756
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2023
Section Cited
CCR
101223(a)(2)
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101223(a)(2) Personal Rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director plans to move furniture to create a section for older infants for their own space and younger infant will have their own space. Director will have a staff meeting regarding supervision and how to handle behavior and will send LPA meeting agenda with signatures of staff.
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Based on information collected, LPA confirmed, this requirement has not been met, Day care child was bitten by other day care child while in care due to inadequate staff supervision, poses a potential health, safety or personal rights risk to persons in care.
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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.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2