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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417275
Report Date: 11/19/2024
Date Signed: 11/19/2024 11:02:45 AM

Document Has Been Signed on 11/19/2024 11:02 AM - 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 JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:BUILDING KIDZ OF SUNNYVALE IN LAKEWOOD VILLAGEFACILITY NUMBER:
434417275
ADMINISTRATOR/
DIRECTOR:		WILSON KOFACILITY TYPE:
850
ADDRESS:878 LAKEWOOD DRIVETELEPHONE:
(408) 737-7022
CITY:SUNNYVALESTATE: CAZIP CODE:
94089
CAPACITY: 38TOTAL ENROLLED CHILDREN: 6CENSUS: 6DATE:
11/19/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Wilson KoTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Mel Matos met with Wilson Ko, Licensee Representative/Director, for an unannounced Annual/Random inspection. LPA toured the indoor and outdoor areas of the Facility during today's inspection. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), menus, and Activity Schedule. Days and hours of operation are Monday through Friday 8:00 AM to 6:00 PM. The Facility is licensed to serve a maximum of thirty eight (38) children ages two to six years in the Orange, Blue, Red, and Yellow Rooms.

LPA reviewed six children's and one staff file (1 director) during today's inspection. Each child's file reviewed contains the required documents; including the Information and Emergency Information form (LIC 700) and immunization records. All staff files reviewed contain the required documents; including transcripts/verification of experience/immunization records, and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Last fire/disaster drill was completed on October 18, 2024. All staff have current CPR and First Aid certifications on file. Wilson understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips).

LPA observed that the teacher/child ratio was in compliance during today's inspection. LPA observed five preschool children with the Director in the Facility during today's inspection. Wilson understands the conditions, limitations, and capacity specifications of the Facility license. Wilson understands that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the Red Room.

LPA observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. The Facility has adequate ventilation, including air conditioning/heating. Wilson states that he cleans the Facility Monday through Friday in the evenings. Wilson understands that the Facility must be kept free of flies and other insects & rodents. LPA observed that all furniture and equipment is in good condition and safe for the children. Drinking water is readily available for the children in the Facility and in the outdoor playground area via reusable water bottles/filtered water source. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Wilson states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors in the Facility.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: BUILDING KIDZ OF SUNNYVALE IN LAKEWOOD VILLAGE
FACILITY NUMBER: 434417275
VISIT DATE: 11/19/2024
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The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. The Facility only provides snacks to the children. Parents provide lunches for the children. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. Wilson states that there are no poisons in the Facility. LPA observed a complete First Aid kit in the Facility. Wilson understands that smoking is not allowed on the Facility premises.

Wilson states that the Facility does not administer any medications at this time. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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

The preschool playground is surrounded by appropriate fencing and the outdoor surfaces are safe for children. The playground equipment is age appropriate and wood chips are used as resilient material. Shade is provided by the building overhang and large trees. Drinking water is available via reusable water bottles/filtered water. There is adequate age appropriate supplies and toys for children in the playground. LPA did not observe any bodies of water during today's inspection. Wilson states that the Facility does not provide transportation.

Wilson Ko, Licensee Representative/Director, was reminded that all adults 18 and over, 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.

Wilson Ko, Licensee Representative/Director, 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.

To improve the quality and value of the new inspection process, a survey will 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 tools, please send them by email 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/process.
Exit interview conducted and report was reviewed with the Licensee Representative/Director, Wilson Ko. No deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Belinda Devall
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC809 (FAS) - (06/04)
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