434404979-10-4-2019-07-CC-SYIP-BGMUUQ-20191004155354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404979
Report Date: 10/02/2019
Date Signed: 10/04/2019 03:54:07 PM

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:	42	CENSUS: 24	DATE:	10/02/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Oksana Oks		TIME COMPLETED:	01:45 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 Analysts (LPAs) Samantha Yip and Nancy Rodriguez conducted an unannounced Case Management- Licensee Initiated. LPAs met with Director Oksana Oks and explained the reason for the inspection. The purpose of this inspection is facility is requesting a decrease in capacity from 42 school-age children to 26 school-age children. Facility is also requesting to change school-age room from Room 3 to Room 5. A fire clearance for 26 school-age children (24 ambulatory and 2 non-ambulatory) was approved on 09/27/2019. The hours of operation are Monday, Tuesday, Thursday, and Friday from 245PM to 6PM and Wednesdays from 1:45PM to 600PM. During school holidays, the hours of operation are Monday through Friday 7AM to 6PM. LPAs toured the inside and outside of facility. The measurement for Room 5 are as followed: 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 does have a waiver to share outdoor space with the preschool program. Facility will be moving outdoor activity area for school-age to preschool yard. The outdoor measurement are as followed: 17.583 x 19 = 338.472 + 14 x 21.833 = 305.662 + 36.167 x 25 = 904.175 + 208.25 + 55 x 25.417 = 1397.935 + 21.500 x 26.583 = 571.534 = 3726.028 minus encumbered space 2(1.583 x 1.500) = 4.749 = 3721.279 Total Outdoor Space: 3721.279 divided by 75 = 49 ------------------continues on 809 dated 10/02/2019 page 2----------------------------------------

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

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: 10/02/2019

NARRATIVE

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-------------------continuation of 809 dated 10/02/2019 page 1-----------------------------------

Facility will be moving an additional chairs and tables from Room 3 to Room 5. There are 30 cubbies. School-age children will be using bathroom next to the lobby. There is 5 sinks, 3 toilets, and 1 urinal. There are separate bathrooms for girls and boys. Disinfectants, cleaning supplies, and all other items that are dangerous to children were observed to be securely stored inaccessible to children. LPAs observed there is sufficient amount of age appropriate toys for children in care. There are tight fitted trash cans for waste. There was a fully charged fire extinguisher, carbon monoxide detector, smoke detector, and completed first aid kit. Director stated there are no weapons at the facility. Shaded rest area is provided through building overhang.

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

Director stated she will submit a written plan for what facility will in case children from the State Preschool are unable to be picked up.

Based on the approved fire clearance capacity and the indoor and outdoor square footage measurements, the facility physical plant has been approved and an updated license reflecting the request to change capacity and room will be issued and effective as of 10/02/2019.

No deficiencies were cited as a result of today's inspection. An exit interview was conducted where this report was discussed and provided to Director Oksana Oks. 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: 10/02/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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