<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414162
Report Date: 06/11/2020
Date Signed: 06/11/2020 04:03:03 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:SAFARI KIDFACILITY NUMBER:
434414162
ADMINISTRATOR:MUDDEEREGOWDA, RASHMIFACILITY TYPE:
850
ADDRESS:20100 STEVENS CREEK BLVDTELEPHONE:
(408) 253-3712
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:96CENSUS: 0DATE:
06/11/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Auxilia WilliamsTIME COMPLETED:
04:00 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
Licensing Program Analyst (LPA) Marilou Monico conducted an announced Case Management inspection via video conference call (Facetime) with Owner, Auxilia Williams. Facility was informed that due to COVID-19 situation this LIC809 Facility Evaluation Report will be emailed to the facility. Facility’s reply to the email will serve as acknowledgement that the report was received.

The Case Management Tele-Inspection is in response to facility’s request to have the Heritage Program use the Preschool Classroom 4 after 12 PM during regular school days and whole day during the summer.

LPA toured the facility both inside and out. The following indoor measurements were taken by LPA Monico on 03/26/15:

CLASSROOM 1 40.581 x 38.249 = 1,552.182 minus 287.089 (encumbered space) = 1,265.093
CLASSROOM 2 34.581 x 21.83 = 754.903 minus 29.979 (encumbered space) = 724.924
CLASSROOM 3 34.000 x 29.747 = 1,011.398 minus 149.728 (encumbered space) = 861.67
CLASSROOM 4 25.83 x 27.332 = 705.985 minus 12.065 (encumbered space) = 693.92
TOTAL INDOOR SPACE = 3,545.607 sq.ft. divided 35 = 101 children

The capacity of the preschool will be reduced to 81 children when the Heritage Program uses Classroom 4.

There were no deficiencies cited.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Marilou MonicoTELEPHONE: (408) 334-8549
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1