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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430702544
Report Date: 06/30/2022
Date Signed: 06/30/2022 01:29:18 PM


Document Has Been Signed on 06/30/2022 01:29 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:WILLOW GLEN COMMUNITY EXT.DAY ENRICHMENT PROGRAMFACILITY NUMBER:
430702544
ADMINISTRATOR:BOBBI URBANOFACILITY TYPE:
840
ADDRESS:1425 LINCOLN AVETELEPHONE:
(408) 287-6999
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:200CENSUS: 42DATE:
06/30/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Bobbi Urbano & Sophia ValdezTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Mel Matos met with Bobbi Urbano, Licensee representative/director, and Sophia Valdez, assistant director, for an unannounced case management inspection. The Facility is currently licensed in Rooms P20, Library, and Cafeteria for 200 school age children. Purpose of today's inspection: Facility request to add Rooms P18 and P19 to the existing license. Existing capacity of 200 to remain unchanged. A fire clearance approval was received from the San Jose Fire Department on May 26, 2022.

The Facility is located on the campus of Willow Glen Elementary School. The Facility operates a year round program and is open from 8 AM to 6 PM during school breaks and 7 AM to 9 AM & 2:50 PM to 6 PM during the regular school year. Since this program operates at a functioning elementary school site, the facility is exempt from the indoor and outdoor square footage requirements, the fencing requirements, toilet/sink ratios, and isolation area requirements.

LPA toured Rooms P18 & P19 and notes that both rooms are safe and in compliance with the Tile 22 Regulations. LPA observed sufficient chairs, tables, and cubbies/storage throughout the Facility. There is adequate equipment, furniture, and supplies for children throughout the Facility.

The Facility only provides PM snacks for the school age children. There is a food preparation area in Room 20 with Hot/cold running water, refrigerator, toaster oven, dishwasher, and microwave. Disposables dishes and utensils are used to serve snacks to the school age children. The Facility has trash cans with tight fitting lids throughout the Facility.

The program will utilize the elementary school playground areas which have age appropriate climbing structures with sufficient resilient materials (artificial turf & padding). Shade is provided by trees and building overhangs. Drinking water will be provided via a combination of water coolers/reusable water bottles both indoors and outdoors. There is adequate equipment and supplies for children outdoors. LPA did not observe any bodies of water during today's inspection.

Exit interview conducted and report was reviewed with the Licensee representative/director, Bobbi Urbano. No deficiencies issued during today's inspection. LPA advised Bobbi that both Rooms P18 & P19 are approved for use effective today, June 30, 2022. An updated license will be sent to the Facility within 1-2 weeks.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:
DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/30/2022
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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