434400006-6-4-2019-07-CC-MSMS-BCTPWT-20190604114116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434400006
Report Date: 06/04/2019
Date Signed: 06/04/2019 11:41:20 AM

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:	BISHOP SCHOOL AGE CDC		FACILITY NUMBER:	434400006
ADMINISTRATOR:	MELANIE LESENE		FACILITY TYPE:	840
ADDRESS:	450 NORTH SUNNYVALE AVE		TELEPHONE:	(408) 739-2611
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94085
CAPACITY:	70	CENSUS: 0	DATE:	06/04/2019
TYPE OF VISIT:	Annual/Random	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jodi Delfino		TIME COMPLETED:	10:15 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Mel Matos met with Jodi Delfino, senior program director, for an announced annual/random inspection. The Facility also submitted a request to the Department to drop Rooms 114 & 116 and add Rooms H101A, H101B, & H102A to the existing license. The licensed capacity will increase from 70 to 105 children. The Facility is located on back section of Bishop Elementary School (facing Hazelton Ave) in Building H. The program is operating at a functioning elementary school site 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 Chief Operations Officer of the Sunnyvale School District is on file for Rooms H101A, H101B, & H102A. Per the capacity letter, all three rooms can accommodate 35 students each; total capacity: 105. LPA observed all required posted materials in each room, 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. A review of staff records on June 4, 2019 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Jodi 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: $100.00 per person per day, 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 violations within a 12 month period. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 06/04/2019):

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BISHOP SCHOOL AGE CDC	FACILITY NUMBER: 434400006
	VISIT DATE: 06/04/2019

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 06/04/2019):

There are sufficient tables, chairs, and cubbies for the children in all three rooms. There is sufficient equipment and supplies for the school age children in all three rooms. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. LPA observed that all rooms are clean and safe for all children and staff. Jodi states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings.

LPA notes that the kitchen/food prep area is located in Room H101A with a refrigerator, dishwasher, microwave, and stove/oven. Drinking water will be provided via drinking fountains indoors and outdoors. School age children will use the elementary playground area and will have exclusive use of the playground area. There are climbing structures in the outdoor area to be used by the school age children and padded squares are used as resilient materials. Shade is provided by building overhangs and canopy area. LPA did not observe any bodies of water during today's inspection.

No deficiencies cited during today's inspection.

LPA conducted an exit interview with Jodi prior to the conclusion of today's inspection and advised her that a license for 105 school age children will be approved upon receipt of an approved fire safety inspection from the Sunnyvale Department of Public Safety.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2019

LIC809 (FAS) - (06/04)

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