434417275-6-7-2022-07-CC-DMAC-CF6SK7-20220607135616

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417275
Report Date: 06/07/2022
Date Signed: 06/07/2022 01:56:31 PM

Document Has Been Signed on 06/07/2022 01:56 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 VILLAGE		FACILITY NUMBER:	434417275
ADMINISTRATOR:	WILSON KO		FACILITY TYPE:	850
ADDRESS:	878 LAKEWOOD DRIVE		TELEPHONE:	(408) 737-7022
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94089
CAPACITY:	38	CENSUS: 5	DATE:	06/07/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Wilson Ko		TIME COMPLETED:	02:15 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	Licensing Program Analysts (LPAs) Dung Mac and Marilou Monico, conducted an unannounced pre-licensing inspection to the facility today. LPAs met with Wilson Ko, Applicant Representative and explained the nature of today's inspection. The facility is still in operation (Facility #434408003) pending the approval of the change of ownership. The Applicant is applying for a license to serve 38 children ages 2 -6 years old. Present were five children and one staff. The facility will operate Monday through Friday from 7:00AM - 6:00PM. LPAs toured and measured the indoor and outdoor areas of the Facility during today's inspection. Indoor Activity Space: ORANGE ROOM = 20.917 x 15.500 = *324.213* BLUE ROOM = (20.917 x 15.500) minus 39.53 (encumbered space) = *284.683* YELLOW ROOM = (22.000 x 16.833) minus 46.483 (encumbered space) = *323.843* RED ROOM = *(42.333 x 11.917) minus 76.978 (encumbered space) = 427.504* *TOTAL INDOOR SPACE = 1,360.243 sq. ft. divided by 35 = 38 children* *Report To Be Continued on Page #2*

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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 OF SUNNYVALE IN LAKEWOOD VILLAGE	FACILITY NUMBER: 434417275
	VISIT DATE: 06/07/2022

NARRATIVE

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Facility has 4 sinks (60) and 5 toilets (75) available for the children. The sinks used by children only have cold running water. Staff have a separate bathroom located in the off-limits storage. Staff bathroom can be utilized by sick children if needed and will be escorted by a staff member. Sick children will be isolated in the Information Room and isolation equipment will be provided. All toilets were observed to have chipping paint. Wilson stated that all the toilets will be replaced.

First aid supplies are stored in each classroom inaccessible to children. Cleaning supplies are stored in the off-limits kitchen. LPAs observed solid waste containers with tight-fitting lids in the classrooms. The facility has functioning smoke and carbon monoxide detectors. All classrooms have appropriate lighting. LPAs observed barricaded wall heaters in the Blue, Red, and Yellow classrooms. The carpet in the Yellow Room has stains. LPAs observed all windows have spider webs.

There are 11 tables, 70 chairs, 48 cubbies, 41 hooks, and 40 cots for the children. There is adequate equipment, supplies and toys for children in each classroom. Drinking water is readily available for the children indoors via individual bottles and water bottles. Transportation will not be provided by the Facility. Wilson states that facility does not administer the medications. Wilson states that there are no poisons and firearms at the facility.

The facility will serve breakfast and AM/PM snacks to the children and there is an off-limits kitchen for food preparation. Children will bring their own lunch. The kitchen is equipped with hot and cold running water, microwave, dishwasher, refrigerator, toaster, and storage space for food. Plastic plates and utensils will be utilized by the Facility.

OUTDOOR MEASUREMENTS:

Preschool Yard: 1/2 (83.750 x 29.250) = 1,224.843
68.000 x 89.167 = 6,063.356
34.833 x 14.333 = 499.261

Toddler Yard: 19.833 x 21.250 = 421.451

TOTAL OUTDOOR SPACE = 8,208.911 sq. ft. divided by 75 = 109 children

Report To Be Continued on Page #3

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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 OF SUNNYVALE IN LAKEWOOD VILLAGE	FACILITY NUMBER: 434417275
	VISIT DATE: 06/07/2022

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The playgrounds are surrounded by appropriate fencing. Shade is provided by several large trees and the building overhang. There are 2 swing sets and one large climbing structure. LPAs observed that the two metal posts of the swings have chipping paint. Wilson stated that he will repaint the posts. The areas around and under the play structure are cushioned with material (wood chips) that absorbs falls.

Drinking water is readily available for the children outdoors via individual bottles and water bottles. LPAs observed no bodies of water at the facility. No storages were observed. LPAs observed that several wood boards of the white lattice fence surrounding an area of the playground have chipping paint. Wilson stated that the fence will be removed. LPAs observed sandbox was covered.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

Applicant Representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Report To Be Continued on Page #4

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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 OF SUNNYVALE IN LAKEWOOD VILLAGE	FACILITY NUMBER: 434417275
	VISIT DATE: 06/07/2022

NARRATIVE

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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 platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPAs reviewed with Applicant Representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Exit interview conducted and report was reviewed with Wilson Ko, Applicant Representative. LPAs advised Wilson that a license for 38 Preschool children will be submitted to Licensing Management for the final stage of approval upon receiving the following items:

1) Photos of all toilets.

2) Photos of playground showing white fence is removed.

3) Photos of windows after removing all spider webs.

4) Photos showing that the two metal posts of the swings have been repainted.

5) Photos showing that the carpet stains in the Yellow Room has been removed.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC809 (FAS) - (06/04)

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