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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404385
Report Date: 07/03/2019
Date Signed: 07/03/2019 11:36:42 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:SJB - NORTHWOOD CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434404385
ADMINISTRATOR:IRENE WONGFACILITY TYPE:
850
ADDRESS:2760 TRIMBLE ROADTELEPHONE:
(408) 538-0200
CITY:SAN JOSESTATE: CAZIP CODE:
95132
CAPACITY:48CENSUS: 28DATE:
07/03/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Irene Wong and Mariel QueTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPAs) Tuoc Doan and Stephanie Collins conducted an unannounced site inspection of the facility. LPA met with Site Director Irene Wong and Regional Director Mariel Que and informed them the purpose of the visit.

Facility plans to temporarily move currently enrolled Preschool children from Portable #600 to Portable #700 while Portable #600 undergoes construction, beginning 07/08/19. Facility will build a wall to create two rooms in Portable #600 for children to use. The work is projected to be completed two weeks from 07/08/19.

Portable #700 was used by the Family Resource Center, but currently the program has ceased operation and they have vacated Portable #700. Facility currently holds a license and fire clearance to use both Portable #600 and #700 for their Preschool Program.

LPAs inspected Portable #700. Smoke and Carbon Monoxide Detectors were observed. Fire Extinguisher was last serviced on 07/2018. LPAs observed facility has a San Jose Fire Safety and Hazardous Materials Permit that expires on 09/30/2019.

Indoor space of Portable #700 was measured to ensure that there is at least 35 square feet of indoor activity space per child.

Portable #700 Indoor Activity Space Measurement
= (Area) – (Encumbered Space)
= (994.694 sq. ft) – (31.836 sq. ft.)
= 962.858 sq. ft.

Total Indoor Activity Space = (962.858 sq. ft.) divided by (35 sq. ft. / child) = 27 Children
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408)324-2151
LICENSING EVALUATOR NAME: Tuoc DoanTELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019
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: SJB - NORTHWOOD CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434404385
VISIT DATE: 07/03/2019
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 Facility stated that they will be relocating some of the children to ensure that they will not have more than 27 children in Portable #700.

There are two toilets and three sinks in Portable #700. LPAs also observed furniture and equipment for children to use. Drinking water is readily available to children. LPAs observed a drinking water fountain inside. The Office room in Portable #700 will be Off Limits to children.

Facility will keep the Department inform about updates on the progress of the project until completion. Exit Interview was conducted, where this report was reviewed and discussed with Site Director and Regional Director.

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: 07/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019
LIC809 (FAS) - (06/04)
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