414004827-8-26-2021-05-CC-SLOO-C69S9Y-20210826134130

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414004827
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:42:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	SILICON VALLEY INTERNATIONAL SCHOOL		FACILITY NUMBER:	414004827
ADMINISTRATOR:	BERGESON, ANGELA		FACILITY TYPE:	850
ADDRESS:	475 POPE STREET		TELEPHONE:	(650) 324-8617
CITY:	MENLO PARK	STATE: CA	ZIP CODE:	94025
CAPACITY:	135	CENSUS: 0	DATE:	08/26/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	Gamilia Elassal		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On August 26, 2021 at 9:00 AM, Licensing Program Analysts (LPAs) Sheran Lo and Leslit Tapia-Mandujano met with Applicant Gamila Elassal today for a pre-licensing inspection. This inspection included a technical assistance inspection for COVID-19 guidance and support. The applicant is requesting 135 children (ages 2 years to entry into first grade). The facility will operate Monday - Friday; 8:00 AM to 5:00 PM. The designated director/site supervisor for the facility is also applicant. The facility was inspected today, indoor and outdoor, for health and safety hazards and measured to calculate capacity. Indoor: There are eight classrooms that will be used for the program and the following square footage was calculated for each room: Room 1(Sun) 1,244.719 sq ft. , Room 2 (Star) 928.112 sq ft., Room 3 (Rainbow) 822.852 sq ft., Room 4 (Moon) 919.084 sq ft., Room 5 (#31) 918.320 sq ft., Room 6 (#32) 871.857 sq ft., Room 7 (#33) 919.800 sq ft., and Room 8 (#34) 922.562 sq ft. Total useable indoor square footage is 7,547.306 sq ft divided by 35 sq ft equals 215 children. The indoor space for children is observed today to be clean and all furnishing, toys and equipment observed to be safe and in good condition. There is storage space for children's personal belongings and mats to be utilized for napping children. Facility will provide a sheet and blanket for children and bedding will sent home to be laundered weekly. Mats will be cleaned at least weekly or more often if needed. Children will be signed in and out with a sheet to be kept in classrooms. The indoor space is equipped with a fire extinguisher, smoke and carbon monoxide detectors, separate kitchen area where snack food is stored, garbage cans with tight-fitting lids, first aid and emergency supplies. The facility is adequately ventilated and free of insects and bugs. Windows are high up inaccessible to children. The program provides two snacks daily and parents will either provide lunch or choose catered lunches. Only disposable products will be used for food served by the facility. Report continues on the next page.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran Lo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SILICON VALLEY INTERNATIONAL SCHOOL	FACILITY NUMBER: 414004827
	VISIT DATE: 08/26/2021

NARRATIVE

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Snack foods will be stored in the kitchen separately from any cleaning products or other hazards. Medications will be stored in the health office area inaccessible to the children; there is a refrigerator located in this area for refrigerated medications. There are _10 toilets (150 capacity) and 10 sinks (150 capacity) accessible for children's use. Bathrooms are located either inside the classrooms or in the hallway. The bathrooms were observed to be clean and with no health and safety hazards. Sinks accessible to children deliver water that is no warmer than 120 degrees. The program will provide a water dispenser and cups for children to drink water indoors. All toxins and other hazardous items will be stored in a locked cabinet in the classroom and will be inaccessible to children. Isolation of ill children will be located in the health office and staff bathroom will be used for an ill child.

Outdoor: The outdoor area measures 14,871.14 sq ft. allowing for a total of 198 children. The outdoor area to be used is enclosed by at least a four foot fence and observed to be clean, safe and equipped with toys and equipment for children. Resilient material located under climbing applicable climbing structures is a pour and play soft padding. There will be individual water bottles to allow children access to drinking water outside. Shade for children will be provided by building structures and tents.

Required postings were observed during today's inspection. Facility will conduct monthly disaster drills and a log will be maintained for review upon request. The fire inspection will conducted today, and applicant will request for a copy if passed. The requirement for Lead Water Testing was discussed (H&S Code 1597.16). Information was provided to applicants during today's inspection. Advisory Note provided to applicants stating that the requirement for testing must be met by January 2023.

This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.

Report continues on the next page.

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran Lo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SILICON VALLEY INTERNATIONAL SCHOOL	FACILITY NUMBER: 414004827
	VISIT DATE: 08/26/2021

NARRATIVE

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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

LPAs conducted a pre licensing inspection today and the inspection included providing the applicants with the COVID-19 self-assessment guide. LPA also reviewed COVID-19 required postings and provided additional COVID-19 resources to applicants. LPA received a copy of the completed self-assessment guide on August 12, 2021.

An electronic copy of this three page report was emailed to applicant Gamilia Elassal on August 26, 2021. Applicant was asked to review the report and return a signed copy of the report to LPA Lo.

LPA Lo will recommend licensure of this facility for a capacity of 135 children once the following is received:

-FIRE CLEARANCE (STD 850) – Can obtain provisional License if cleared
-FINANCIAL RELEASE AND VERIFICATION (LIC 404)-
-ADMINISTRATIVE ORGANIZATION (LIC 309)-
-MONTHLY OPERATING STATEMENT (LIC 401)-
-BALANCE SHEET (LIC 403)-
-PERSONNEL REPORT (LIC 500)-
-HEALTH SCREENING REPORT (LIC 503) and immunization records
-EMERGENCY DISASTER PLAN (LIC 610)-
-FACILITY SKETCH (LIC 999)
-VERIFICATION OF DIRECTOR QUALIFICATIONS-
-JOB DESCRIPTIONS-
-PERSONNEL POLICIES-
-IN-SERVICE TRAINING FOR STAFF-
-PARENT HANDBOOK-
-DISCIPLINE POLICIES (for Preschool/pre-K)-
-ADMISSION POLICIES-
-ADMISSION AGREEMENT-
-SCHEDULE OF DAILY ACTIVITIES-
-SAMPLE MENU-
-LIST OF FURNITURE AND/OR PLAY EQUIPMENT-

SUPERVISOR'S NAME: Garfield Leung	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sheran Lo	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC809 (FAS) - (06/04)

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