430702544-8-29-2019-07-CC-SRED-BFHVML-20190829163343

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430702544
Report Date: 08/29/2019
Date Signed: 08/29/2019 04:33:48 PM

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:	WILLOW GLEN COMMUNITY EXT.DAY ENRICHMENT PROGRAM		FACILITY NUMBER:	430702544
ADMINISTRATOR:	LYLA SNYDER		FACILITY TYPE:	840
ADDRESS:	1425 LINCOLN AVE		TELEPHONE:	(408) 287-6999
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	200	CENSUS: 171	DATE:	08/29/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	03:40 PM
MET WITH:	Bobbi Urbano		TIME COMPLETED:	04:45 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	Licensing Program Analyst (LPA), Shannel Reed, conducted an unannounced random annual/ random inspection to the facility today. LPA met with Director, Bobbi Urbano, and explained the nature of today's inspection. LPA toured the facility both inside and outside during today's visit. There were 171 children present with 14 staff (11 teachers / 3 Aides) and the Director. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), and Parents' Rights Poster (PUB 393). LPA observed that the teacher/child ratio was in compliance during today's inspection.The Director understands the conditions, limitations, and capacity specifications of the facility license. The Director understands that children shall be visually supervised at all times. The facility is aware of the required sign in and sign out procedures for school age children who arrive on their own. The Director states that school age children are picked up by their parent(s)/guardian(s). There is a waiver on file for electronic sign in and out. LPA observed that all rooms are clean and safe for all children and staff. The Director states that the facility is cleaned by the school janitors in the evenings. Drinking water is readily available for the children in each room and in the outdoor playground area via drinking fountains. LPA observed solid waste containers with tight-fitting lids in each room. Children's bathrooms are clean, sanitary, and operable. There are separate staff bathrooms. The Director states that there are no weapons or firearms on the premises. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less. Cleaning supplies are inaccessible to the children and stored in locked cabinets inaccessible to children. There are no poisons on site. The Director understands that any poisons must be locked and inaccessible to the children. LPA observed all furniture and equipment is in good condition and safe for the children. REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 08/29/2019):

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: WILLOW GLEN COMMUNITY EXT.DAY ENRICHMENT PROGRAM	FACILITY NUMBER: 430702544
	VISIT DATE: 08/29/2019

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
26
27
28
29
30
31
32

CONTINUATION OF PREVIOUS PAGE (REPORT DATED 08/29/2019):
The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. There is sufficient resilient materials in the outdoor playground area. LPA did not observe any bodies of water during today's inspection.

Due to time constrains, LPA will return to the facility to complete the Annual/Random inspection.

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

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2