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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434413755
Report Date: 10/05/2022
Date Signed: 10/05/2022 03:18:26 PM


Document Has Been Signed on 10/05/2022 03:18 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:AFTER SCHOOL ADVENTURESFACILITY NUMBER:
434413755
ADMINISTRATOR:NASRIN ZARKUBFACILITY TYPE:
840
ADDRESS:1840 HARRIS AVENUE ROOM #31TELEPHONE:
(408) 264-8400
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY:60CENSUS: 29DATE:
10/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nasrin ZarkubTIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA), James Santos conducted an unannounced Required 1 Year inspection today and met with Nasrin Zarkub, Licensee/Director.

LPA toured the facility with Licensee which provides after school care. The program is located in a big classroom (Room 31, located behind the elementary school) and is licensed to serve children from kindergarten to fifth grade. The operation days and hours are the following: M-F - 7 to 8:15am; M,T,Th, F - 2 to 6pm and Wednesdays from 1-6pm.

The required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269) and Activity Schedule are posted.

The room is divided into three (3) separate classroom areas. LPA observed that all 3 classroom areas are clean, organized and safe for all children and staff. LPA observed solid waste containers with tight-fitting lids in each classroom. Licensee stated that there are no weapons or firearms on the premises. All snacks and beverages that require refrigeration are stored in covered containers in the refrigerator. Chemicals and cleaning supplies are stored and inaccessible to the children. LPA observed all furniture and equipment is in good condition and safe for the children. Fire extinguishers, fire alarm, smoke and carbon monoxide detectors and first aid kits were observed in the facility.

The outside playground area was observed to be safe and free of hazards. The outdoor play equipment are in good condition and the surface area has sufficient resilient materials. There are no bodies of water observed. Drinking water is available for the children in the classroom and in the outdoor playground area.

LPA reviewed five (5) staff records. Staff records reviewed include Criminal Record Clearance, Immunization Record, CPR/First Aid, Mandated Reported Training, Qualifications and Education.

The annual inspection will be continued on a later date. Exit interview conducted and report was reviewed and a copy was provided to Licensee, Nasrin Zarkub.


NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: James G SantosTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2022
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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