434408015-8-21-2019-07-CC-SRED-BF9PY6-20190821114324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408015
Report Date: 08/21/2019
Date Signed: 08/21/2019 11:43:29 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:	ANDERSON VILLAGE STATE PRESCHOOL		FACILITY NUMBER:	434408015
ADMINISTRATOR:	SHERYL CHAN		FACILITY TYPE:	850
ADDRESS:	4000 RHODA DRIVE		TELEPHONE:	(408) 874-3100
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY:	30	CENSUS: 0	DATE:	08/21/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Jeanette Escobar		TIME COMPLETED:	11:50 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) Shannel Reed made an unannounced case management inspection to the facility today. LPA Reed met with Director, Jeanette Escobar. The purpose of this visit was in response to facility's request for an increase in capacity from 30 to 66 preschool aged children. Facility has requested to add rooms A3 and A4 to the Preschool license. During today's inspection, there were no children present as the new school year begins on August 22, 2019. LPA observed two (2) Teachers preparing their classrooms for the school year. Current rooms for the Preschool license are rooms J1 and J2. (New rooms being added- measured on 08/21/19) Total Space Measured for Additional Preschool: INDOOR MEASUREMENTS ARE AS FOLLOWS: A3- Large Classroom Area: 24 x 16.67 = 400.08 minus 0 (encumbered) = 400.080 A3- Small Play Area: 14.42 x 11.08 = 159.7736 minus 0 (encumbered) = 159.774 A4- Large Classroom Area: 24 x 16.67 = 400.08 minus 0 (encumbered) = 400.080 A4- Small Play Area: 14.42 x 11.08 = 159.7736 minus 0 (encumbered) = 159.774 TOTAL ADDITIONAL INDOOR SPACE: 1119.707 sq. ft. divided by 35 = 31 children. OUTDOOR MEASUREMENTS AND INFORMATION ARE AS FOLLOWS: (Measured by School District) LARGE PLAYGROUND AREA: 11, 057 sq. ft. (Measured by LPA Reed on 08/21/19) SMALL EXTENDED PLAYGROUND AREA: 53.33 x 45.83 = 2444.1139 minus 0 (encumbered) = 2444.114 TOTAL OUTDOOR CAPACITY SPACE= 13501.114 Divided by 75 (SQ. FEET) EQUALS= 180 children REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 08/21/2019):

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019

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: ANDERSON VILLAGE STATE PRESCHOOL	FACILITY NUMBER: 434408015
	VISIT DATE: 08/21/2019

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 08/21/2019):

There are 4 (60) toilets, 4 sinks (60) for the preschool children. The rooms operate only with an AM program from 8AM to 11 AM Monday through Friday. The facility will provide Lunch instead of AM snack from the school cafeteria. Drinking water is available in each classroom via water fountain and water pitcher with disposable cups. Outside drinking water is available via two (2) water fountains. The Program has two approved Waivers for the Moreland Special Day Class to commingle with the PM State Preschool classroom and an Approved Alternative Mandated Reporter Training.

Based on todays measurements of rooms A3 and A4, the maximum increased capacity is 31 children in addition to the previously approved capacity of 30 children in rooms J1 and J2. This gives the facility a total maximum capacity for the preschool program of 61 children. The Fire Clearance was approved on 08/05/19.

Facility's request for an increase in capacity may be approved for 61 Preschool children pending notification to SJFD regarding the change in requested capacity and Licensing Manager approval.

No deficiency cited during the visit.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel Reed	TELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019

LIC809 (FAS) - (06/04)

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