434412005-10-13-2020-07-CC-MMOO-BUCN57-20201013100905

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412005
Report Date: 10/13/2020
Date Signed: 10/13/2020 10:11:26 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:	ST. JOSEPH OF CUPERTINO PRESCHOOL		FACILITY NUMBER:	434412005
ADMINISTRATOR:	JEAN WILSON		FACILITY TYPE:	850
ADDRESS:	10120 NORTH DE ANZA BLVD.		TELEPHONE:	(408) 252-9778
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY:	40	CENSUS: 0	DATE:	10/13/2020
TYPE OF VISIT:	Case Management - Other	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Michael Lee		TIME COMPLETED:	10:00 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	On October 13, 2020 at 9:00 a.m., Licensing Program Analyst (LPA), Marilou Monico, met Principal, Michael Lee, for an announced tele-inspection via Facetime. LPA advised Michael 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 years to entry into kindergarten in the Pre-school Room. Principal Michael Lee guided LPA on a tour of the facility via Facetime. The program plans to operate Monday - Friday, from 08:00 a.m.- 3:30 p.m except for Wednesdays, the children will be dismissed at 12:30 p.m. The program plans to serve children 5th to 7th grade. The program plans on conducting daily health screening via ParentSquare app. Children will be drop off and pick up at the parking lot. If child/ren become ill during the course of the day, they will be placed in an isolation area (pop-up tent outside the office). The program plans to use the following classrooms: Grade 5, 6, and 7. The facility plans to have 8 children with 1 staff per classroom. Outdoor activities are planned to take place at the playground/field next to preschool playground, which is enclosed by 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 Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

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: ST. JOSEPH OF CUPERTINO PRESCHOOL	FACILITY NUMBER: 434412005
	VISIT DATE: 10/13/2020

NARRATIVE

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Medication will not be administered at the facility.

The program plans to utilize the following restrooms which provide for individual privacy:
Restroom next to Grade 4 (Boys) - 2 urinals, 5 toilets, and 6 sinks
Restroom next to Grade 7 (Girls) - 8 toilets and 6 sinks

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

Community Care Licensing will provide on-going Technical Assistance (TA) to St. Joseph of Cupertino 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 Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou Monico	TELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020

LIC809 (FAS) - (06/04)

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