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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274404880
Report Date: 07/11/2019
Date Signed: 07/11/2019 10:45:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:GREENFIELD USD OAK AVE. PSFACILITY NUMBER:
274404880
ADMINISTRATOR:JACQUELINE VALENCIAFACILITY TYPE:
850
ADDRESS:1239 OAK AVENUETELEPHONE:
(831) 674-2431
CITY:GREENFIELDSTATE: CAZIP CODE:
93927
CAPACITY:20CENSUS: 0DATE:
07/11/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Dr. Limary GutierezTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Joe Macias conducted a Case Management Inspection. LPA met with the Director Dr. Limary Gutierez, and explained the nature of today's visit. LPA toured the Facility both inside and outside during todays visit. LPA noted that the Facility is located on the Oak Elementary School campus, in room 37. The facility has recently submitted an application for an increase of capacity. The facility is currently licensed to provide care for 20 children, the requested increase would bring the total capacity to 24 children. LPA Macias remeasured the facility during today's inspection.

Measurements taken during today's inspection:


ROOM 37 = 26.247 x 39.212 = 1,029.197 minus 26.04 (encumbered space) = 1,003.157
TOTAL PRESCHOOL INDOOR SPACE: 1,003.157 sq. ft. divided by 35 = 28 children.

There are 2 sinks (30), and 2 toilets (30) available for the children. Only cold water is available in the children's sinks. There are staff bathrooms located in the Preschool office. The sick child will use the Staff Bathroom located in the Preschool office. The sick child will be isolated in the Nurse's Office and isolation equipment is provided. The facility currently has ample equipment and supplies for the requested increase of capacity. There are a total of 25 chairs, 6 tables, and 20 cubbies. There is a total of 25 mats/ cots.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: GREENFIELD USD OAK AVE. PS
FACILITY NUMBER: 274404880
VISIT DATE: 07/11/2019
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Outdoor Measurements taken during today's inspection:
Outdoor square footage is 3234.017 divided by 75 = 43 children

The yard is surrounded by appropriate fencing. Shade is provided by building awning, and trees. The outdoor equipment is age appropriate.

Exit interview conducted, and a copy of this report was provided to the facility. LPA advised the Directoe that the increase of capacity will be granted pending Management approval.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
LIC809 (FAS) - (06/04)
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