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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408015
Report Date: 09/05/2019
Date Signed: 09/05/2019 05:54:37 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:ANDERSON VILLAGE STATE PRESCHOOLFACILITY NUMBER:
434408015
ADMINISTRATOR:SHERYL CHANFACILITY TYPE:
850
ADDRESS:4000 RHODA DRIVETELEPHONE:
(408) 874-3100
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:30CENSUS: 0DATE:
09/05/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Amarjit KaurTIME COMPLETED:
06:05 PM
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Licensing Program Analyst (LPA) Shannel Reed made an unannounced case management inspection to the facility today. LPA Reed met with Site Supervisor, Amarjit Kaur. The purpose of this visit was in response to facility's request for an increase in capacity from 30 to 61 preschool aged children. Facility has requested to add rooms A3 and A4 to the currently Licensed J1 and J 2 classrooms. During today's inspection, there were no children present with LPA and the Site Supervisor.
Total Space Measured for Preschool Classrooms:
INDOOR MEASUREMENTS ARE AS FOLLOWS:
(Re- measured on 09/05/19 by LPA Reed)
J1: 38.92 x 22.33 = 869.0836 minus 67.795 (encumbered) = 801.289
J2: 36.33 x 20.83 = 756.7539 minus 183.128 (encumbered) = 573.626
(New rooms measured on 08/21/19 by LPA Reed)
A3- Classroom: 24 x 16.67 = 400.08 + 14.42 x 11.08 minus 0 (encumbered) = 559.854
A4- Classroom: 24 x 16.67 = 400.08 + 14.42 x 11.08 minus 0 (encumbered) = 559.854
TOTAL ADDITIONAL INDOOR SPACE: 2494.622 sq. ft. divided by 35 = 71 children.

OUTDOOR MEASUREMENTS AND INFORMATION ARE AS FOLLOWS:
(Re- measured on 09/05/19 by LPA Reed)
Playground- Large: 89.17 x 82.42 = 7349.391 minus 497.073 (encumbered) =6852.318
Playground- Grass Area: 58.83 x 25.67 = 1510.166minus 0 (encumbered)= 1510.166
(Measured by LPA Reed on 08/21/19)
Playground- Bike Area: 53.33 x 45.83 = 2444.113 minus 0 (encumbered)= 2444.113
TOTAL OUTDOOR SPACE: 10806.597 sq. ft. divided by 75 = 144 children

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 09/05/2019):
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
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: ANDERSON VILLAGE STATE PRESCHOOL
FACILITY NUMBER: 434408015
VISIT DATE: 09/05/2019
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 09/05/2019):

There are 6 toilets (2 in J1 & J2 and 4 in A3 & A4), 8 sinks (4 in J1 & J2 and 4 in A3 & A4) 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 today’s measurements of rooms J1 and J2 and the 8/21/19 measurements of A3 and A4, the maximum increased capacity is 71 children. However, the Program Director, Jeanette Escobar stated that they wish to increase to only 61 children. The Fire Clearance was approved on 08/05/19 for 66 children.

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 KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Shannel ReedTELEPHONE: (408) 489-9484
LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2019
LIC809 (FAS) - (06/04)
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