434404979-12-12-2019-07-CC-SYIP-BJSMUQ-20191212085533

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404979
Report Date: 12/11/2019
Date Signed: 12/12/2019 08:55:37 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:	LOS ARROYOS CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434404979
ADMINISTRATOR:	OKSANA OKS		FACILITY TYPE:	840
ADDRESS:	885 MORO DRIVE		TELEPHONE:	(408) 843-9005
CITY:	GILROY	STATE: CA	ZIP CODE:	95020
CAPACITY:	26	CENSUS: 0	DATE:	12/11/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	11:36 AM
MET WITH:	Oksana Oks and Trena Hudson		TIME COMPLETED:	01:10 PM

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 unannounced Case Management- Licensee Initiated. LPA met with Director Oksana Oks and explained the reason for the inspection. The purpose of this inspection is License is requesting to change capacity from 26 to 28 children. A fire clearance for 28 children including non-ambulatory was approved on 09/27/2019. LPA Yip and LPA Rodriguez measured Room 5 on 10/02/2019. The measurement for the indoor space is as followed: Room 5: 35 x 29.333 = 1026.655 + 9.667 x 2 = 19.334 + 7.917 x 2.167 = 17.156 + 2.917 x 8 = 23.336 = 1086.481 minus encumbered space 8 x 1.250 = 10 = 1076.481 Total Indoor Space: 1076.481 divided by 35 = 30 Facility will be using a the school age/preschool yard adjacent to Room 3 for the school age. Facility does have a waive to share outdoor space with the preschool program. The measurement for outside are as followed: School-Age/ State Preschool Yard: 20.333 x 2 + 9 x 27 + 37.833 x 25 + 17 x 7 + 13.917 x 5 + 32.333 x 15.333 minus encumbered space 1.500 x 1.667 = 2.500 = 1911.336 Total Outdoor Space: 1911.336 divided by 75 = 25 LPA inspected the room and observed that there is sufficient amount of chairs, tables, and cubbies for children's use. Children will be using the restroom next to the lobby. There are separate bathrooms for girls and boys. Bathroom for children was observed to be sanitary. There is sufficient amount of toys for children in care. All disinfectant, cleaning supplies, and other items that are dangerous to children were observed to be stored inaccessible. -----continues on 809 dated 12/11/2019 page 2----------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019

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: LOS ARROYOS CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434404979
	VISIT DATE: 12/11/2019

NARRATIVE

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Storage container for waste has a tight fitted lid. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Program Director stated that there are no weapons, such as firearms, stored on the premise.

The outdoor activity area is fenced. There is sufficient amount of toys and equipment for children. There were no bodies of water observed during today's inspection. Shaded rest area is provided through pergola and building overhang. Director stated that the State Preschool is only a half day program; therefore, the preschool and school-age program will never be commingled.

Facility does provide snacks to children in care. Menu was observed to be posted. Kitchen used to prepare snacks was observed to be sanitary. Drinking water is provided through water fountains.

Based on the approved fire clearance capacity and the indoor square footage measurements, an updated license reflecting the request to change capacity will be issued upon approval of Licensing manager and completion of the following:

waiver request for outdoor square footage for the school-age by 12/20/2019

No deficiencies were cited as a result of today's inspection. An exit interview was conducted where this report was discussed and provided to Program Director Trena Hudson. A notice of site visit has been issued and must be posted for 30 consecutive days.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019

LIC809 (FAS) - (06/04)

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