430701981-8-11-2022-07-CC-KMEO-CH7UTS-20220811155226

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430701981
Report Date: 08/11/2022
Date Signed: 08/11/2022 03:52:33 PM

Document Has Been Signed on 08/11/2022 03:52 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	WOODHAVEN PRESCHOOL AT WILLOW GLEN UMC		FACILITY NUMBER:	430701981
ADMINISTRATOR:	SMITH, SUSAN		FACILITY TYPE:	850
ADDRESS:	1420 NEWPORT AVENUE		TELEPHONE:	(408) 294-6072
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	48	CENSUS: 0	DATE:	08/11/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Susan Smith		TIME COMPLETED:	04:15 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	Licensing Program Analysts (LPAs) Kassandra Medrano and Mel Matos met with Licensee representative/director, Susan Smith, for an announced case management inspection. Purpose of today's case management inspection: The Facility is requesting to add Pre-K Room 3 to the existing preschool license. The capacity remains unchanged at 48 preschool children. Hours of operation: 8:00AM to 12:00 AM (AM session) and 1 PM to 4 PM (PM session) Monday to Friday. Program operates along the San Jose Unified School District schedule. Susan states that school is currently on summer recess and scheduled to resume on August 22, 2022. The Facility is currently licensed in the following rooms: Rooms Pre-K 1, Pre-K 2, Music Room, Art Room, Block Room. Measurements for Rooms Pre-K 1, Pre-K 2, Pre-K 3, Music Room, Art Room, and Block Room are as follows: Pre-K 1: 34.833 x 16.133 = 561.960(minus 9.000 + 43.52 = 52.52) = 509.440 Pre-K 2: 34.250 x 16.000 = 548.000 (minus 9.000 x 1.000 = 9.000) = 539.000 Pre-K 3: 31.833 x 16.133 = 513.562 (minus 39.336 + 4.5 = 43.836) = 469.258 Art Room: 21.417 x 17.500= 374.798 (minus 6.917 x 2.750 = 19.022) = 355.776 Block Room: 19.333 x 13.083 = 252.934 Music Room: 18.917 x 16.083 = 304.242 *TOTAL INDOOR CLASSROOM SPACE: 2, 430.65 sq. ft. divided by 35 = 69 preschool children.* There is sufficient sinks (5), toilets (5), chairs (48), tables (10), cubbies/hooks (56), supplies, and equipment for the children within all five rooms. The program operates two part time sessions daily (AM/PM sessions) and thus no napping is provided. The Facility only provides AM/PM snacks for the preschool children. Drinking water is available for the preschool children indoors via disposable cups. Susan Smith, Licensee representative/director, was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: WOODHAVEN PRESCHOOL AT WILLOW GLEN UMC	FACILITY NUMBER: 430701981
	VISIT DATE: 08/11/2022

NARRATIVE

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LPAs observed that the preschool playground areas are surrounded by appropriate fencing. There is adequate equipment, supplies, and toys for the preschool children outdoors. The preschool playground areas have age appropriate & secure play structures. There are sufficient resilient materials underneath and surrounding the play structures in both playgrounds (wood chips). Shade is provided via trees and shade sails. Drinking water is also available for the preschool children outdoors.

OUTDOOR MEASUREMENTS:

Preschool Playground (near Room Pre-K 3) - 25.000 x 25.167 (minus 8.167 x 6.167= 50.366) = 578.809
Preschool Playground (near Art Room ) - 23.083 x 31.167 = 719.428
Preschool Playground (near swings)- 69.417 x 34.583 = 2,400.648
Preschool Playground (near climbing structure)- 39.000 x 45.583 = 1,777.737

TOTAL OUTDOOR SPACE: 5,476.622 sq. ft. divided by 75 = 73 preschool children.

Fire Clearance from San Jose Fire Department has not to be received as of 08/11/2022.

LPAs conducted an exit interview with Susan Smith, Licensee representative/director, and advised her that room Pre-K 3 will be approved & added to the Licensee upon receipt of the following:

1. Fire Clearance approval from the City of San Jose Fire Department.

Notice of site visit issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022

LIC809 (FAS) - (06/04)

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