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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416419
Report Date: 08/31/2022
Date Signed: 08/31/2022 04:29:38 PM

Document Has Been Signed on 08/31/2022 04:29 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BUILDING KIDZ SCHOOLFACILITY NUMBER:
434416419
ADMINISTRATOR:MANALI AMAR DOSHIFACILITY TYPE:
850
ADDRESS:4115 JACKSOL DRIVETELEPHONE:
(408) 559-1003
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 73TOTAL ENROLLED CHILDREN: 46CENSUS: 35DATE:
08/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Manali Doshi and Adela TIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection at the day care center today and met with Manali Doshi, Licensee and Adela Bjelevac, Director. Today's visit was also in regards with the case management visit conducted by the Department on 12/1/2021 about the incident that occurred on 11/29/2021, when a substitute teacher went to the bathroom through the gate but was not aware that the gate did not fully closed. As a result, a child ran out and was reported found in the courtyard by a school district staff who brought the child back. The child was doing ok after the incident.

LPA toured the indoor and outdoor areas with Licensee and Director. The required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393) and Child Car Seat Law (PUB 269) are posted by the entrance area.

The preschool program are held in 3 classrooms: Pollywog (Rm #12), Octopus (Rm #11) and Dolphins (Rm #17). The classroom areas, furniture and equipment were observed to be clean and organized. There are age appropriate toys available for children. Fire extinguishers, fire alarm, smoke and carbon monoxide detectors and first aid supplies were observed in each classrooms. The children's bathrooms were observed to be clean and sanitary. Chemicals and cleaning solutions are stored in the laundry area inaccessible to children. Per Licensee, there are no poisons, weapons or firearms on the premises. Drinking water is readily available for the children indoor and outdoor via water pitcher. The rooms have solid waste containers with tight-fitting lids.

The day care center provides breakfast, snacks and lunch for the children. LPA observed the kitchen area where food is prepared and is free of litter and rubbish, rodents and vermins. LPA observed the kitchen is equipped with refrigerator, microwave, oven, and stove.

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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BUILDING KIDZ SCHOOL
FACILITY NUMBER: 434416419
VISIT DATE: 08/31/2022
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The outside playground area is surrounded by appropriate fencing and was observed to be safe and free of hazards. The outdoor play equipment are in good condition and the surface area has sufficient resilient materials. There are no bodies of water observed.
A waiver for preschool children to share playground request was approved.

LPA reviewed ten (10) children's files. Children's records reviewed include Admission Agreement, Identification and Emergency Contact, Consent for Emergency Medical Treatment form, receipt of Parent Rights Notice, Personal Rights Notice, Physician's Report and Immunization Record.

LPA reviewed eight (8) staff files. Staff records reviewed include Criminal Record Clearance, Immunization Record, CPR/First Aid, Mandated Reported Training, Qualifications and Education.

Per review of record, the center conducts emergency disaster drills every month. Last drill conducted was in August 2022.

The day care center provides Incidental Medical Services (IMS). The children's medications are stored in the medication boxes in the locked cabinet in each classrooms. Licensee stated that they do not provide transportation to children.

Licensee and Director were reminded of applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person up to $3000.00 per person.


Care providers are encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.

No deficiencies cited. Exit interview conducted and report was reviewed with Licensee and Director. A copy of the report was provided.


NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022
LIC809 (FAS) - (06/04)
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