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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700718
Report Date: 02/05/2025
Date Signed: 02/05/2025 10:41:16 AM

Document Has Been Signed on 02/05/2025 10:41 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BUILDING KIDZ PALO ALTOFACILITY NUMBER:
435700718
ADMINISTRATOR/
DIRECTOR:		BUI, CATHYFACILITY TYPE:
850
ADDRESS:415 LAMBERT AVENUETELEPHONE:
(650) 673-3700
CITY:PALO ALTOSTATE: CAZIP CODE:
94306
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 25DATE:
02/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Cathy BuiTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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On 02/05/2025 at 9:35am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu conducted an unannounced case management inspection for the purpose of investigating a reported incident. LPA met with Director Cathy Bui. Also present during the inspection were six (6) fingerprint-cleared staff and 25 children in care. The facility is within ratio and in compliance with capacity regulations today.

The reported incident occurred on 01/27/2025 and was reported to Licensing on 01/29/2025. Per director, one (1) preschooler entered a classroom adjacent to the designated classroom and was left unsupervised for approximately 45 seconds when transitioning indoors from the outdoor play area.

During today’s inspection, LPA reviewed the above information with Director and conducted an interview to obtain more information. The facility was toured to conduct a Health and Safety Inspection of the classroom where the child was reportedly unsupervised. During the incident, the child was transitioning from the outdoor play area to the classroom. LPA also reviewed camera footage of the classroom where the incident occurred. Present were two (2) teachers and ten (10) children. When walking back to the classroom, which is two doors down the hallway from the outdoor play area, the child entered the first classroom and closed the door. The classroom the child entered is the child’s regular daytime classroom and did not have any teachers or children inside at the time of the incident. Because it was the end of the day, all classrooms were combined, and the second classroom was the designated classroom for all children. About 45 seconds later, the child’s parent arrived for pick-up and found the child in the classroom unsupervised and reported it to the teacher. Based on the obtained information and LPA’s observation, LPA determined the child was left unsupervised, which posed an immediate threat to the health and safety of the child in care. After this incident, the following actions has been taken by the facility: director spoke with the child’s parent to discuss measures to strengthen supervision protocols in order to prevent a similar incident, all staff underwent re-training on supervision during transitions with a focus on active supervision, and stricter name-to-face checks is enforced. Director will also implement new transition protocols that includes supervision checkpoints and hallway monitoring. To ensure accountability, director will conduct random transition observations. This incident will also be reviewed during the monthly staff meeting.

Page 1 of 2. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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 3
Document Has Been Signed on 02/05/2025 10:41 AM - It Cannot Be Edited


Created By: Jialing Zhu On 02/05/2025 at 10:17 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BUILDING KIDZ PALO ALTO
FACILITY NUMBER: 435700718

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/06/2025
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision 101229(a)(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
This requirement was not met as evidenced by:
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LPA obtained sufficient information from Director to conclude this deficiency has been addressed with all parties involved within the facility. Precautions following this incident have also already been taken. (See LIC 809 for the information LPA obtained and observations of precautions taken as a result.)
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Based on LPA observations and interview, the licensee did not comply with the section cited above as a child was left unsupervised in the classroom, which posed an immediate threat to the health and safety of the child in care.
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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 Charles
LICENSING EVALUATOR NAME:Jialing Zhu
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BUILDING KIDZ PALO ALTO
FACILITY NUMBER: 435700718
VISIT DATE: 02/05/2025
NARRATIVE
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Absence of supervision is a Zero Tolerance violation. As a result, a Type A deficiency is issued during today’s inspection.

As a result of the Type A deficiency cited during today’s inspection, a copy of this report and LIC 9224 Acknowledgment of Receipt of Licensing Reports must be provided to parents/guardians of current enrolled children in care and all children newly enrolled following a 12-month period of this report. The LIC 9224 must be signed within the next business day the children are in care and is to be kept in the children’s files.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted, report was reviewed, and Appeal Rights were provided to Director Cathy Bui.

Page 2 of 2. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC809 (FAS) - (06/04)
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