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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435700718
Report Date: 03/05/2025
Date Signed: 03/05/2025 01:42:20 PM

Document Has Been Signed on 03/05/2025 01:42 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
OAKLAND SOUTH EAST, 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: DATE:
03/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Director, Cathy Bui TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Saini met with Director Cathy Bui for an unannounced case management inspection in response to an Unusual Incident that the Facility self reported to the Department on 2/25/2025.

LPA Saini conducted interviews with the center director and staff and obtained pertinent documents. Based on interviews and record reviews, the facility acknowledged that on 02/25/2025, the child left the premises around 11:28 AM. C1 left the building and was brought back in by a bystander who observed C1 leaving the premises. The bystander returned the child to the facility, having been missing from 11:28 AM to 11:38 AM which concludes that the facility did not provide adequate supervision to children in care. Absence of supervision is a Zero Tolerance violation. As a result, a Type A deficiency is issued during today’s inspection. California Code of Regulations, Title 22, Division & Chapter Number 101229(a)(1)} is being cited on the attached LIC 809D.

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.

An immediate civil penalty of 1000$ for repeat violation is assessed today.

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.

SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Jyoti Saini
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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Document Has Been Signed on 03/05/2025 01:42 PM - It Cannot Be Edited


Created By: Jyoti Saini On 03/05/2025 at 12:42 PM
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: 03/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/06/2025
Section Cited
CCR
101229(a)(1)

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101229(a)(1)Responsibility for Providing Care and Supervision:(a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation
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The director shall submit a written plan to the Community Care Licensing Division (CCLD) outlining how the facility and staff will always ensure the complete supervision of all children in care. The director shall also conduct in-house training on care and supervision, provide a copy to all staff members, and have them sign the plan. The facility shall have staff watch the "Supervising Children in Child Care Centers" video at ccld.childcarevideos.org, obtain a written statement from each staff member outlining their understanding, and submit it to the Community Care Licensing Division by POC date.
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Based on the interview and record review, the facility did not comly with the section cited above.C1 left the building and was brought back in by a bystander who observed C1 leaving which poses an immediate health and safety risk to children in care.
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An immediate civil penalty of 500$ is assessed today.

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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:Wynn Norona
LICENSING EVALUATOR NAME:Jyoti Saini
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2025


LIC809 (FAS) - (06/04)
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