434403563-10-7-2020-07-CC-SYIP-BU6PDX-20201007111415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434403563
Report Date: 10/07/2020
Date Signed: 10/07/2020 11:15:12 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:	SACRED HEART PRE-SCHOOL		FACILITY NUMBER:	434403563
ADMINISTRATOR:	CAMARENA, JUDY		FACILITY TYPE:	850
ADDRESS:	13718 SARATOGA AVENUE		TELEPHONE:	(408) 867-9241
CITY:	SARATOGA	STATE: CA	ZIP CODE:	95070
CAPACITY:	32	CENSUS: 0	DATE:	10/07/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Thomas Pulchny		TIME COMPLETED:	11:08 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) Samantha Yip conducted an announced Case Management-Other inspection. Due to COVID-19 and shelter in place, a tele-inspection was conducted via Zoom. LPA met with Mr. Thomas Pulchny, Principal, and explained the reason for the inspection. Mr. Pulchny was advised that this Facility Evaluation Report (LIC 809) will be emailed to the facility. Facility's reply to the email within 24 hours will serve as acknowledgement and the report was received. The purpose of this inspection was to provide technical assistance in response to a waiver request for 14 school age children to attend the facility. Facility is currently licensed to serve 2 years 9 months to kindergarten. Mr. Pulchny guided LPA on a tour of the facility via Zoom. The program plans to operate Monday through Friday from 8:00AM to 3:30PM and will serve children in grade kindergarten to 5th grade. Facility plan on conducting daily health screening via ParentSquare app. Children have designated areas on campus for drop off/out. If child/ren become ill during the course of the day, they will be placed in an isolation area located in the office. The program plans to use the following classrooms at this location: Extended Care Room and School Library. Each classroom will have a maximum of 14 children. Outdoor activities are planned to take place at the playground next to Extended Care Room, which is enclosed with fencing. -----------------------CONTINUES ON 809 DATED 10//2020 PAGE 2---------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

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: SACRED HEART PRE-SCHOOL	FACILITY NUMBER: 434403563
	VISIT DATE: 10/07/2020

NARRATIVE

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----------------CONTINUATION OF 809 DATED 10/07/2020 PAGE 1----------------------------

Children will bring snacks and lunch from home. The program will ensure that children have access to drinking water at all times via water bottle filler stations.

Medication will be administered if parents provide it.

The program plans to utilize the following restrooms which provide for individual privacy:
boy's restroom (2 sinks, 3 urinals, 5 toilets) and girl's restroom (6 toilets and 2 sinks).
Sanitizing stations are in place throughout the buildings.

Community Care Licensing will provide on-going Technical Assistance (TA) to Sacred Heart Pre-School.

Please feel free to contact the San Jose Child Care Regional Office at (408) 324-2148.

Regional Manager: Carol Marcroft, telephone (408) 324-2150
Licensing Program Manager: Sandy Knight, telephone (408) 324-2151
Licensing Program Manager: Anthony Studebaker, telephone (408) 324-2155
Licensing Program Analyst: Samantha Yip, telephone (408) 529-8128

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2020

LIC809 (FAS) - (06/04)

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