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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400230
Report Date: 07/14/2021
Date Signed: 07/14/2021 01:03:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MVWSD PRESCHOOL AT LATHAMFACILITY NUMBER:
434400230
ADMINISTRATOR:TERRI KEMPERFACILITY TYPE:
850
ADDRESS:1850 LATHAM STTELEPHONE:
(650) 526-3560
CITY:MOUNTAIN VIEWSTATE: CAZIP CODE:
94041
CAPACITY:72CENSUS: 0DATE:
07/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Terri KemperTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Melanie Otsuji arrived to the facility to conduct a Case Management - Licensee initiated inspection. LPA met with Applicant/Director, Terri Kemper. Applicant has applied to add two additional playgrounds (Castro and Mistral Kindergarten Playgrounds) and a grassy area (nearest preschool portables) to licensed play space. The existing capacity of 72 preschool aged children remains unchanged. This campus is located between Castro and Mistral Elementary School Campuses. Facility operates Monday through Friday 8:00AM to 3:00PM and follows school year calendar. No children or staff were present during today's inspection since the program is currently on summer break until August 11, 2021.

LPA toured the indoor and outdoor space and measurements of Mistral Kindergarten playground, Castro Kindergarten playground and Grassy Area nearest preschool portables were taken during today's inspection. The indoor space remains unchanged.

INDOORS: 3125.55 square feet = 89 children
OUTDOORS: 16485.07 square feet = 220 children

There are sufficient equipment, toys, and supplies indoors and outdoors for the preschool children. A waiver to utilize elementary school play yards will be requested. There are 7 sinks and 5 toilets available for children use. There is a staff bathroom located in the Office. Isolation areas for sick children will be either school campuses nurses station where a preschools staff member will accompany them until an authorized representative picks the child up. A fire clearance approval from the Mountain View Fire Department for a capacity of 72 children was received on 6/2/2021.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: MVWSD PRESCHOOL AT LATHAM
FACILITY NUMBER: 434400230
VISIT DATE: 07/14/2021
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No deficiencies issued during todays inspection.

Approval for use of the Kindergarten playgrounds on Castro Elementary and Mistral Elementary plus the grassy area nearest preschool portable is effective on today's date, 7/14/2021.

Notice of Site visit was provided to the applicant and must remain posted for the next 30 days.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
LIC809 (FAS) - (06/04)
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