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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710561
Report Date: 02/24/2023
Date Signed: 02/24/2023 11:15:11 AM


Document Has Been Signed on 02/24/2023 11:15 AM - 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:CALIFORNIA YOUNG WORLD AT ELLISFACILITY NUMBER:
430710561
ADMINISTRATOR:JOSEPHINE FELIXFACILITY TYPE:
840
ADDRESS:550 EAST OLIVE STREETTELEPHONE:
(408) 774-0405
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY:56CENSUS: 11DATE:
02/24/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Nora LacayoTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA), Mel Matos, conducted an announced follow up case management inspection to the Facility today in response to a request received by the Department to drop Portables A & B from the existing license and add Rooms P-9 & P-10 to the existing license. LPA met with Nora Lacayo, director, and explained the nature of today's inspection to her. The Facility is located on the campus of Ellis Elementary School. The licensed capacity remains unchanged (56 school age children). Hours of operation: 6:30 AM to 8 AM - Monday to Friday, 2 PM to 6 PM - Monday to Thursday, and 12:45 AM to 6 PM - Friday. Room P-10 will only be used in the afternoons, after 11:30 AM, and Room P-9 is available all day.

The program is operating at a functioning elementary school site (Ellis Elementary School) and thus is exempt from the indoor and outdoor square footage requirements, fencing requirements, toilet/sink ratios, and isolation area requirements. No measurements were taken of the indoor and outdoor spaces during today's inspection. A capacity letter signed by the Director of Facilities & Operations for the Sunnyvale School District is on file for Rooms P-9 & P-10. Per the capacity letter, Rooms P-9 & P-10 can accommodate 34 students each; total available capacity: 68. A fire clearance approval from Sunnyvale Department of Public Safety was received by LPA prior to today's inspection.

LPA reminded Nora that all required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule must be posted in Rooms P-9 & P-10.

There are sufficient tables, chairs, and hooks for the children in Rooms P-9 & P-10. There is sufficient equipment and supplies for the school age children in both rooms. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable.

LPA notes that the kitchen/food prep area is located in Room P-9. Drinking water will be provided via drinking fountains & water jugs cups/water bottles indoors and outdoors. School age children will use the playground area, located behind Rooms P-9 & P-10. There is a climbing structure in the outdoor area that is safe/secure and age appropriate. There is sufficient materials for outdoor use for the school age children. Resilient materials are sufficient underneath and surrounding the play structure. Shade is provided by building overhangs.

LPA conducted an exit interview with Nora prior to the conclusion of today's inspection and advised her that a license for 56 school age children in Rooms P-9 & P-10 is approved effective today, February 24, 2023. Notice of site visit issued 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: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2023
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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