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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434408055
Report Date: 01/30/2023
Date Signed: 01/30/2023 03:41:36 PM

Document Has Been Signed on 01/30/2023 03:41 PM - It Cannot Be Edited

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:YMCA - ALLEN @ STEINBECKFACILITY NUMBER:
434408055
ADMINISTRATOR:JOAN KHOOSHABEHFACILITY TYPE:
840
ADDRESS:820 STEINBECK DRIVETELEPHONE:
(408) 819-6536
CITY:SAN JOSESTATE: CAZIP CODE:
95123
CAPACITY: 108TOTAL ENROLLED CHILDREN: 40CENSUS: 24DATE:
01/30/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:Sarah Thomas and Audrey Voss
TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Janette Cruz conducted a site inspection of the facility today and met with Sarah Thomas, Director and Audrey Voss, Program Director. LPA explained to Sarah and Audrey the purpose of the visit and inspected the facility inside and out. The inspection is in response to facility’s request for a decrease in the School-age license maximum capacity from 108 to 72. The Fire Department has been notified of the decrease in capacity and had granted a fire clearance for the decrease on 12/13/2022.

The School-age program is located at Allen@Steinbeck Elementary School and is licensed to operate in Portable Classrooms P8, P9 and A. However, facility had informed Licensing Office on 11/8/22 that YMCA will no longer have access to Room A. Since the program is operated at a functioning elementary school site, the facility is exempt from the indoor measurement and outdoor square footage requirements, the fencing requirements, toilet/sink ratios and isolation area requirements. Capacity letters from the San Jose Unified School District was received by Licensing indicating that both classrooms P8 and P9 can accommodate 36 children.

The following item must be completed prior to approval of decrease in capacity of the license:
1) Receipt of qualified school-age director documents.

There are no deficiencies cited during the visit.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30
DAYS.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Janette Cruz
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2023
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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