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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406735
Report Date: 07/28/2021
Date Signed: 07/28/2021 12:06:11 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:FOREST HILL PRESCHOOLFACILITY NUMBER:
434406735
ADMINISTRATOR:HEATHER ELSTONFACILITY TYPE:
850
ADDRESS:4450 MCCOY AVENUETELEPHONE:
(408) 364-4279
CITY:SAN JOSESTATE: CAZIP CODE:
95130
CAPACITY:60CENSUS: 20DATE:
07/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Virginia EigenTIME COMPLETED:
12:20 PM
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Licensing Program Analysts (LPAs), Marilou Monico and Cortney Nelson, met with Child Development Specialist, Virginia Eigen, and conducted a case management inspection in response to licensee's request to remove Room 32 (renamed Room 35) on the license. LPAs toured the facility both inside and outside.

Measurements of the following classrooms were taken by LPA Tse on 08/07/2014:
ROOM E: (28.664 x 9.083) + (38.166 x 8.415) + (35.83 x 4.747)
= 260.355 + 321.166 + 170.085
= 751.606 minus 28.911 (encumbered space)
= 722.695 sq. ft. divided by 35 = 20 children
ROOM D: 25.664 x 23 = 590.272 minus 42.624 (encumbered space)
= 547.648 sq. ft.

Measurements of the following classrooms were taken by LPA Tse on 04/28/2015:
ROOM B: 30.332 x 23.083 = 700.153 minus 68.09 (encumbered space)
= 632.063 sq. ft.
ROOM C: (5.581 x 8.498) + (23 x 30.415) = 47.427 + 699.545
= 746.972 minus 55.339 (encumbered)
= 691.633 sq. ft.
TOTAL PRESCHOOL INDOOR SPACE:2594.039 sq. ft. divided by 35 = 74 children

There are 4 toilets (60) and 4 sinks (60) for the children. There are 78 cubbies, 25 tables, 120 chairs, and 27 mats for the daycare children. Most of the children attend on a part-time basis and will not nap at the center.

When Rooms B, C & D will be used by the Forest Hill Elementary, the capacity will be dropped to 20 children.
Continuation on next page:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: FOREST HILL PRESCHOOL
FACILITY NUMBER: 434406735
VISIT DATE: 07/28/2021
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 07/28/21):

Playground measurements taken by LPA Tse on 08/07/14:
108 x 45 = 4860
TOTAL OUTDOOR SPACE 4860 sq. ft. divided by 75 = 64 children

As a result of this inspection, the request to remove Room 32 on the license is approved effective today.

A NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2