434408015-5-6-2020-07-CC-JTSE-BPCU28-20200506151130

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434408015
Report Date: 05/06/2020
Date Signed: 05/06/2020 03:11:38 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 PRESCHOOL		FACILITY NUMBER:	434408015
ADMINISTRATOR:	JEANETTE ESCOBAR		FACILITY TYPE:	850
ADDRESS:	4000 RHODA DRIVE		TELEPHONE:	(408) 874-3100
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95117
CAPACITY:	61	CENSUS: 0	DATE:	05/06/2020
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jeanette Escobar		TIME COMPLETED:	03:30 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	LPA Janet Tse met with site director Jeanette Escobar via a tele Case Management inspection due to the COVID-19 pandemic. The preschool is applying for change of classrooms and new playground usage. Fire clearance was conducted and approved by the San Jose Fire Department on 03/10/2020. The preschool is currently closed. Present were Director and a maintenance personnel, Jared Amaral, who will be assisting Director to take measurements of the classrooms and the new playground. Classrooms J1 and J2 and the old playground will no longer be used by the preschool. A new playground in between the classrooms will be used instead of the old playground. Classrooms to be used by the preschool will be P1, P2, A3, and A4. INDOOR MEASUREMENTS: Measurements taken by LPA Reed on 09/05/2019: 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. Measurements taken today: P1 Classroom: 25 x 29.167 + 21.500 x 13.583 = 729.175 + 292.034 = 1021.209 minus 49.539 (encumbered) = 971.670 P2 Classroom: 25 x 29.167 + 21.500 x 13.583 = 729.175 + 292.034 = 1021.209 minus 49.539 (encumbered) = 971.670 *TOTAL INDOOR SPACE:* 559.854 + 559.854 + 971.670 + 971.670 *= 3063.048 sq. ft. divided by 35* = *87 children* OUTDOOR MEASUREMENTS: Playground: 90.250 x 36.917 + 60 x 60.417 / 2 = 3331.759 + 1812.510 = *5144.269* *TOTAL OUTDOOR SPACE:* *5144.269 sq. ft. divided by 75 =* *68 children* Facility Evaluation Report dated 05/06/2020 to be continued on next page: - Page 1 of 2 -

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2020

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: 05/06/2020

NARRATIVE

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There are seven toilets (105) and ten sinks (150). The playground has artificial turf as resilient material. Shades are provided by shade structures. The rooms operate with an AM program from 8:00am to 11:00am, and an PM program from 11:35am to 2:35pm, Monday through Friday. The facility will provide full meal lunch. AM lunch is served at 10:30am and PM lunch is at 12:30pm. Drinking water is available in each classroom via water fountain and water pitcher with disposable cups. Outside drinking water is available via pitcher. 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.

Licensure to use the A3, A4, P1, P2 classrooms and the new playground for a capacity of 61 children is pending on Licensing Management's approval.

A copy of this Licensing report with LPA's signature only will be emailed to Director. In lieu of Director's signature, a read receipt to LPA's email will serve as Director's acknowledgement of receipt of this report.

This is an amended report for the tele-inspection conducted on 05/06/2020. This amended will be emailed to Director with LPA's signature. I lieu of Director's signature, a read receipt to LPA's email will servie as Director's acknowledgement of receipt of this amended report.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Janet Tse	TELEPHONE: (408) 334-8547
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2020

LIC809 (FAS) - (06/04)

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