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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430709472
Report Date: 10/11/2022
Date Signed: 10/11/2022 02:46:35 PM


Document Has Been Signed on 10/11/2022 02:46 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:YMCA-BOOKSINFACILITY NUMBER:
430709472
ADMINISTRATOR:TONI BROWNFACILITY TYPE:
840
ADDRESS:1590 DRY CREEK ROADTELEPHONE:
(408) 265-3588
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY:140CENSUS: 29DATE:
10/11/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Deborah PaselkTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Kassandra Medrano and Mel Matos met with Director, Deborah Paselk for a case management inspection. Purpose of today's inspection: Reduction of room usage and licensed capacity. LPAs explained the nature of today's inspection to Deborah and toured the indoor/outdoor areas of the Facility during today's inspection.

The current Facility is located on the campus of Booksin Elementary School (under the San Jose Unified School District), behind the community garden. The Facility is currently licensed in Portables: 1, 2, 3, and Room 24. The San Jose Unified School District has renamed the Portables - what was previously Portables 1 & 2 is now Room F and Portable 3 is now Room G. The Facility has requested to remove two classrooms Room F & 24 from the license. The licensed capacity will reduce from 140 school age children to 35 school age children in Room G only.

The Facility operates at a functioning elementary school site and thus is exempt from the indoor and outdoor square footage requirements, fencing requirements, and toilet/sink ratios and isolation area requirements.

A capacity letter from the San Jose Unified School District listing the maximum capacity for Room G as 35 children was received prior to today's inspection. A fire clearance approval for Room G was also received from the San Jose Fire Department prior to today's inspection.

LPAs conducted an exit interview with Director, Deborah Paselk, and advised her that a license for 35 school age children in Room G is approved today, October 11, 2022.

No deficiencies issued during today's inspection. Notice of site visit issued and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana StephensonTELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2022
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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