<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417275
Report Date: 05/23/2022
Date Signed: 05/23/2022 02:45:37 PM

Document Has Been Signed on 05/23/2022 02:45 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 OF SUNNYVALE IN LAKEWOOD VILLAGEFACILITY NUMBER:
434417275
ADMINISTRATOR:WILSON KOFACILITY TYPE:
850
ADDRESS:878 LAKEWOOD DRIVETELEPHONE:
(408) 737-7022
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 0DATE:
05/23/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Wilson KoTIME COMPLETED:
02:40 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
Office meeting to review latest application corrections for pending preschool license. LPM Mary Segura reviewed the items that need correction and or updating with applicant representative Wilson Ko.
The following items still need correction and or revision prior to conducting the prelicensing inspection.

1. LIC 309 update needed
2. LIC 403 and LIC 403 a need signatures/date.
3. LIC 610 needs signature/date
4. Lease needs updating tenant/landlord information
5. Verification of 3 months start up costs (LIC 404) needs to be returned from bank.
6. Employee handbook needs revisions.
7. Job descriptions need revisions.
8. Staff training needs revisions/updates.
9. Parent Handbook needs revisions/updates.
10. Admission Agreement needs revisions/updates.
11. Snack menu needs revisions, submit breakfast menu.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Mary Segura
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2022
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 1