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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700718
Report Date: 11/01/2021
Date Signed: 11/03/2021 08:52:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BUILDING KIDZ PALO ALTOFACILITY NUMBER:
435700718
ADMINISTRATOR:PATEL, VIBHUTIFACILITY TYPE:
850
ADDRESS:415 LAMBERT AVENUETELEPHONE:
(650) 224-2144
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY:96CENSUS: 35DATE:
11/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Vibhuti PatelTIME COMPLETED:
04:00 PM
NARRATIVE
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On 11/01/2021 at 9:00am, Licensing Program Analyst (LPA) Christina Uribe & Licensing Program Manager (LPM) Chandra Charles conducted an unannounced Annual Required Inspection and met with Licensee Vibhuti Patel. LPA Uribe disclosed the purpose of the inspection and was granted entry into the facility by the licensee. Present during the inspection was 35 Preschool students & 6 fingerprint cleared staff members. The center consists of 6 classrooms in 1 building. The hours of operation are 7:00a-6:00p, Monday-Friday.

CLASSROOMS: The six classrooms were inspected, only 3 rooms are being used (Little Lamb, Jellyfish, & Bumble Bee Rooms). Teacher-child ratio was observed. There are adequate play and learning materials available. There is adequate heating/air conditioning, ventilation, & lighting. The floors, furniture and equipment are age-appropriate and in good repair. Drinking water is available inside and outside of the center. There is proper individual storage space for each child. The isolation area for sick children is in the #4 & #6 classrooms. LPA Uribe tested one carbon monoxide detector and one smoke detector located in the hallway. Both devices were functional. The center is equipped with a working telephone, carbon monoxide detector, pull down fire alarms and 3 fully charged 3A10BC fire extinguisher. All solid waste storage containers have tight fitting covers on and appears to be in good repair.

BATHROOMS & TOILETING AREAS: There are separate bathrooms for staff and children. Toilets and faucets are in safe and sanitary operating condition. The children are able to reach the sinks and toilets. Supplies are available to children.

FOOD SERVICE AREAS: The kitchen is clean, adequately equipped, and LPAs did not observe any food stored with cleaning supplies. The menus are posted at least one week in advance, available for review and dated.

Continued on LIC 809C

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BUILDING KIDZ PALO ALTO
FACILITY NUMBER: 435700718
VISIT DATE: 11/01/2021
NARRATIVE
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OUTDOOR PLAY AREAS: There are no bodies of water, or free-standing water accessible to children. There are age appropriate toys and materials for the children. The playground outside is fenced and all equipment and surfaces are free from hazards.

RECORDS: All individuals subject to criminal record review have a clearance and have been associated to the facility. Children’s files and staff files were reviewed around 11:00am. LPA Uribe advised the licensee that two separate Facility Rosters are required for each facility type and licensee will email a copy to the LPA when it is completed and no later than within 10 days from today's date. At least one opening/closing staff member has a current CPR/First-Aid Certificate. Mandated Reporter Training was discussed, and certificates were reviewed. Director’s CPR/First-Aid Certificate is current. The center is in compliance with the sign in and out procedure. Per director, there are no firearms stored on the premises. All required documents are posted in a publicly accessible area. LPA Uribe observed that one employee does not have TB clearance or a health screening report on file resulting in a Type B Violation. It was also observed that two children's files were missing physician/dentist information on the Identification & Emergency Information (LIC 700) form resulting in a Type B Violation.

HEALTH RELATED SERVICES: LPA Uribe inspected the medication, which is stored in a safe place that is inaccessible to children in care. One child's medication is expired and is not stored with it's original packaging/prescribing label resulting in a Type B Violation. The center is equipped with a fully stocked first-aid kit and available in the classrooms.

California Law requires Family Child Cares licensees to report unusual incidents or injuries to children in care to child's parents and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or electronic mail. Roster of the children must be properly maintained and fire/disaster drill every six months must be documented. The director was reminded that Licensing needs to be informed prior to use of additional areas in the facility.

Licensee 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.

Continued on LIC 809C

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BUILDING KIDZ PALO ALTO
FACILITY NUMBER: 435700718
VISIT DATE: 11/01/2021
NARRATIVE
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Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing 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 attached type B violations is cited today and must be corrected by the due date. The attached Advisory Notes state the Technical Violations & Technical Advisories given to the licensee during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Vibhuti Patel.

SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BUILDING KIDZ PALO ALTO
FACILITY NUMBER: 435700718
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
Personnel Requirements
(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review of S2, the licensee did not comply with the section cited above in which person poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/11/2021
Plan of Correction
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S2 will need to complete TB clearance/Health Screening Report. Licensee will scan and email LPA once it is completed no later than 11/11/2021. If S2 is unable to meet this due date, she will not be permitted to return to facility.
Type B
Section Cited
CCR
101221(b)(7)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (7) Name, address and telephone number of the child's physician and dentist and any other medical/dental or mental health providers.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in identifiers which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/05/2021
Plan of Correction
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Licensee will have the Identification & Emergency Information from filled out in its entirety from the children's parents/authorized representative. All sections must be filled out, scanned and email to the LPA no later than 11/05/2021.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2021
LIC809 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BUILDING KIDZ PALO ALTO
FACILITY NUMBER: 435700718
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(2)
Health-Related Services
(2) All prescription and nonprescription medications shall be maintained with the child's name and shall be dated.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in objects which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/16/2021
Plan of Correction
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Licensee must immediately return any expired medications to parent's of C4. Additionally, Licensee will email LPA with photo of appropriate label and prescribing medication that has child's name and current date no later than 11/16/2021.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Christina UribeTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2021
LIC809 (FAS) - (06/04)
Page: 5 of 5