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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709448
Report Date: 03/08/2023
Date Signed: 03/08/2023 12:51:47 PM


Document Has Been Signed on 03/08/2023 12:51 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:PRIMARY PLUS - INFANTSFACILITY NUMBER:
430709448
ADMINISTRATOR:LOPEZ, LORENAFACILITY TYPE:
830
ADDRESS:18720 BUCKNALL ROADTELEPHONE:
(408) 370-0350
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY:83CENSUS: 50DATE:
03/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Lorena LopezTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA), Pete Hernandez, met with Site Director, Lorena Lopez, and conducted a case management inspection in response to licensee's request to expand and build an outdoor playground space for the infant children in lieu of the current shared outdoor space waiver. The purpose of the visit is to assist by calculating if the proposed area to be fenced off for the infant playground will be adequate outdoor space for the current capacity of 83 infants. LPA toured the indoor and outdoor areas. The following outdoor measurements taken are based on the facility sketch areas submitted on 3/2/2023 to CCLD:

INFANT YARD 1 in front of rooms 1, 2, and 3:128 x 22= 2816 minus 56 (encumbered space) = 2760 sq ft.

NEW PROPOSED INFANT YARD 2 in front of rooms K5 and K6: 55 x 67 = 3685 sq ft.

TOTAL OUTDOOR SPACE: 6445 sq ft divided by 85 = children

Yard 1 and 2 are enclosed with appropriate fencing. Shade is provided by trees and building overhang. Drinking water is readily available to children via individual water bottles.

Staff present during the inspection have cleared criminal record and child abuse index clearances or exemptions. LPA also reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2023
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: PRIMARY PLUS - INFANTS
FACILITY NUMBER: 430709448
VISIT DATE: 03/08/2023
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The following items must be completed prior to Management approval of the changes of outdoor space for the infants.

1) The new infant playground must be built and measured and inspected by CCLD.

Exit interview conducted and report was reviewed with the Director, Lorena Lopez,


NOTICE OF SITE VISIT WAS AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Gladys KuizonTELEPHONE: (510) 566-5850
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC809 (FAS) - (06/04)
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