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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435700718
Report Date: 05/09/2024
Date Signed: 05/09/2024 04:57:05 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/13/2024 and conducted by Evaluator Michael Mathew
COMPLAINT CONTROL NUMBER: 52-CC-20240313112759
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:
05/09/2024
UNANNOUNCEDTIME BEGAN:
03:46 PM
MET WITH:Priya SudharsanTIME COMPLETED:
05:16 PM
ALLEGATION(S):
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Staff do not ensure that the facility is free of pests.
INVESTIGATION FINDINGS:
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On 5/9/24 at,3:10 PM Licensing Program Analyst (LPA) Michael Mathew conducted an unannounced inspection to conclude a complaint investigation and completed a COVID-19 pre-screening questions prior to entering the facility. LPA met with Director Priya Sudharsan and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 35 children and 7 staff in care at the time of the inspection.

Allegation: Staff do not ensure that the facility is free of pests.Based on LPAs interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation of Staff do not ensure that the facility is free of pests. is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 Chapter 1 Article 07. Physical Environment 101238 Buildings and Grounds , are being cited on the attached LIC 9099D.

A notice of site visit and appeal rights were given. Exit interview conducted and report was reviewed with Director Priya Sudharsan
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 52-CC-20240313112759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 ALTO
FACILITY NUMBER: 435700718
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2024
Section Cited
CCR
101238(a)(1)
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Title 22, Division 12 Chapter 1 Article 07. Physical Environment 101238 Buildings and Grounds (a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety......
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The facility representative will submit a written plan of correction with methods and procedures to prevent pest infestation to LPA by 5/23/24 due date via email
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Based on the LPA obersavations, staff reporting party and parent interviews, the condition of the facility indicates that the facility failed to be free from pest.
This requirement was not met as evidence. This poses an immediate risk to the Health, Safety and personal rights
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 The facility representative shall conduct and document a staff meeting and or training on the facility safe, healthful and comfortable accommodations. The facility representative shall forward a copies to LPA by 5/23/24.
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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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024
LIC9099 (FAS) - (06/04)
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