430701997-5-11-2022-07-CC-JGSS-CEBUMN-20220511154236

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430701997
Report Date: 05/11/2022
Date Signed: 05/11/2022 03:43:09 PM

Document Has Been Signed on 05/11/2022 03:43 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ST. TIMOTHY'S CHRISTIAN PRESCHOOL		FACILITY NUMBER:	430701997
ADMINISTRATOR:	JEANETTE ADAMS		FACILITY TYPE:	850
ADDRESS:	5100 CAMDEN AVENUE		TELEPHONE:	(408) 265-0244
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY: 85	TOTAL ENROLLED CHILDREN: 68	CENSUS: 36	DATE:	05/11/2022
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Jeanette Adams		TIME COMPLETED:	03:55 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), James Santos and Marilou Monico conducted an unannounced case management visit today and met with Director, Jeanette Adams. The purpose of today's case management is due to the facility's request to add a room (D6) to all the other licensed rooms: C3, C4, C5, C6, C7, D1 and D2. Indoor measurements taken by LPA, Oscar Huang on 6/5/2020: C3: (Library) 23.50 x 23.25 = 546.375 - 23.520 (encumbered space) = 522.855 D2: 35.5 x 23.469 = 833.150 - 46.938 (encumbered space) = 786.211 Other Indoor Measurements taken by LPAs, Stephanie Rangel & Nancy Rodriguez on 09/10/2019: C4: 14.083 x 23.833 + 20.667 x 9.083 + 3.333 x 2.583 = 531.968 - 33.481 (encumbered space) = 498.487 C5: 25.250 x 23.667 = 597.592 - 41.777 (encumbered space) = 555.815 C6: 23.167 x 24.083 = 557.930 - 48.177 (encumbered space) = 509.753 C7: 23.250 x 26.833 = 623.867 - 43.494 (encumbered space) = 580.373 D1: 32.083 x 29.750 = 954.469 - 2.013 (encumbered space) = 952.456 LPAs Santos and Monico toured the facility today with Director and took the measurements for the additional room (D6). D6: 33.250 x 23.500 = 781.375 - 17.812 (encumbered space) = 763.563 *TOTAL INDOOR SPACE: 5,169.513 sq.ft divided by 35 = 147 children* *Continued on* *next page*

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ST. TIMOTHY'S CHRISTIAN PRESCHOOL	FACILITY NUMBER: 430701997
	VISIT DATE: 05/11/2022

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There are total 12 sinks (180), 7 toilets & 5 urinals (150) available for children. Bathrooms are located outside of the classrooms. Staff bathrooms are located in both staff office & staff lounge rooms. Sick child will be isolated in staff office and will utilize staff office bathroom if needed.

Court Yard: 70 x 37.083 = 2,595.81
+ 81.750 x 79 = 6,458.25
Court Yard Total = 9,054.06 - 136.222(encumbered) = 8,917.438
Outdoor Classroom Yard = 102.583 x 23.333 = 2,393.569 - 31.625 = 2,361.944

TOTAL OUTDOOR SPACE: 11,279.382 divided by 75 sq. ft. = 150 children

The center has exclusive use of the playgrounds. Playgrounds are completely surrounded with appropriate fencing. There are climbing structures with tan bark as resilient material under the play structures and surrounding area. Shade is provided by building overhang and trees. LPAs did not observe any bodies of water.

Fire clearance for 85 children was granted on April 20, 2022.

LPA conducted an exit interview and advised Site Director, Jeanette Adams, that Room D6 will be added on the license pending management approval.

No deficiencies cited during today's inspection.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: James G Santos
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2022

LIC809 (FAS) - (06/04)

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