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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434411603
Report Date: 10/29/2020
Date Signed: 10/29/2020 11:01:16 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:HOLY FAMILY SCHOOL PRESCHOOLFACILITY NUMBER:
434411603
ADMINISTRATOR:JOANN HOGINSFACILITY TYPE:
850
ADDRESS:4701 JOSEPH SPECIALE DRIVETELEPHONE:
(408) 978-1355
CITY:SAN JOSESTATE: CAZIP CODE:
95136
CAPACITY:36CENSUS: 12DATE:
10/29/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Vida CovingtonTIME COMPLETED:
11:00 AM
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On October 29, 2020 at 10:00 AM, Licensing Program Analyst (LPA), Marilou Monico, met Principal, Vida Covington, for an announced tele-inspection via Zoom Meeting. LPA advised Vida that this Facility Evaluation Report (LIC 809) will be emailed to the facility. Facility’s reply to the email within 24 hours will serve as acknowledgement that the report was received.

The purpose of the tele-inspection was to provide technical assistance in response to a waiver request for 24 school age children to attend the facility due to the spread of COVID-19 in California. The facility is currently licensed for children ages 3 to 5 years.

Principal Vida Covington guided LPA on a tour of the facility via Zoom Meeting. The program plans to operate Monday - Friday, from 8:00 AM- 3:00 PM. The program plans to serve children in first to fourth grade.

The program plans on conducting daily health screening via ParentSquare app. Drop off and pick up will be at Gates A and B . If child/ren become ill during the course of the day, they will be placed in an isolation area (Pop-up tent) located in front of Building C.

The program plans to use the following classrooms: Rooms 3 & 4 in Building B and Room 10 in Building D. The facility plans to have 12 children with 1 staff in each room. Outdoor activities are planned to take place at the playground close to Building B & C, which is enclosed with fencing.

Children will bring food for snacks and lunch from home. The program will ensure that children have access to drinking water at all times.

Continuation on next page:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020
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: HOLY FAMILY SCHOOL PRESCHOOL
FACILITY NUMBER: 434411603
VISIT DATE: 10/29/2020
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Only prescribed medication with doctor's note will be administered at the facility.

The program plans to utilize the following restrooms inside the gym which provide for individual privacy:
Girls Bathroom - 2 toilets and 1 sink
Boys Bathroom - 1 toilet, 1 urinal, and 1 sink

Hand washing and sanitizing stations are in place throughout the facility.

LPA advised Principal Vida Covington to submit an updated facility sketch adding the drop off/pick up locations.

Community Care Licensing will provide on-going Technical Assistance (TA) to Holy Family School Preschool.

Please feel free to contact the San Jose Child Care Regional Office at 408-324-2148.

Regional Manager: Carol Marcroft, telephone 408-324-2150
Licensing Program Manager: Sandy Knight, telephone 408-324-2151
Licensing Program Manager: Anthony Studebaker, telephone (408) 334-8553
Licensing Program Analyst: Marilou Monico, telephone 408-334-8549
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2020
LIC809 (FAS) - (06/04)
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