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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710215
Report Date: 09/10/2019
Date Signed: 09/10/2019 02:54:59 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:CUMBERLAND CDCFACILITY NUMBER:
430710215
ADMINISTRATOR:LIPP, CINDYFACILITY TYPE:
840
ADDRESS:824 CUMBERLAND DRIVETELEPHONE:
(408) 736-0179
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:140CENSUS: 88DATE:
09/10/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Cindy LippTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Tuoc Doan conducted an unannounced Case Management site visit in response to facility's notification of a change in facility's physical plant. LPA met with Director Cindy Lipp and explained to her the purpose of the inspection. Cumberland CDC is currently a licensed School Age Program operating on a functioning school site, Cumberland Elementary. The School Age Program is licensed to operate in Portable Classrooms A, B, C, and P-1. However, facility had informed Licensing Office that beginning this school year, P-1 has been removed from the Elementary School campus.

In place of P-1, the School Age Program will be using Portable Classroom 34. A fire clearance has been granted for Portable Classrooms A, B, C, and 34 on 09/09/19. Facility had submitted letters from the Elementary School Principal stating that each Portable Classroom has an approved capacity of 35 children.

LPA inspected the Portable Classrooms, including Portable Classroom 34. LPA observed that items that may pose a danger to children were stored inaccessible to children. There were furniture, such as tables and chairs available for children. Since this School Age Program operates on a functioning school site, pursuant to Health and Safety Code Section 1596.806 the Program is exempt from requirements for square-footage of indoor and outdoor activity space, toilet, fencing, and isolation space for child day care centers, pursuant to Health and Safety Code Section 1596.806.

Based on today's inspection, LPA determined that the facility's physical plant is in compliance with applicable Health & Safety Codes and Title 22 Regulations. Therefore, a School Age License is hereby issued for Cumberland CDC to operate in Portable Classrooms A, B, C, and 34, effective today, 09/10/19

Exit interview was conducted, where this report was reviewed with Director Cindy Lipp. A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2019
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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