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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414162
Report Date: 12/03/2021
Date Signed: 01/12/2022 01:28:23 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: 5DATE:
12/03/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:12 PM
MET WITH:MUDDEEREGOWDA.RASHMITIME COMPLETED:
03:54 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stephanie Collins met with Site Director MUDDEEREGOWDA, RASHMI explained the nature of the inspection and conducted an unannounced pre-licensing inspection in response to the facility’s request to decrease their capacity from 96 to 76 preschool children age 2 to 6 years of age and add a Toddler Component to service 12 Toddlers’ 18 to 36 months of age in classroom # 3. Room 3 has two (2) sinks and 2 toilets inside the classroom dedicated to the toddler component. The fire clearance was granted 11/16/2021. LPA observed sufficient teach ratio coverage. LPA toured the facility both inside and out. The following indoor measurements were taken by LPA Monica on 03/26/15:
TOTAL INDOOR SPACE=
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 4 25.83 x 27.332 = 705.985 minus 12.065 (encumbered space) = 693.92
TODDLER CLASSROOM 3 34.000 x 29.747 = 1,011.398 minus 149.728 (encumbered space) = 861.67
TOTAL INDOOR SPACE = 3545.607 sq. ft. divided 35 = 101 children
There are a total of 9/135 sinks and 1/165 toilets/urinals available to children in care.

OUTDOOR MEASUREMENTS:
TODDLER PLAYGROUND Area : 949.72 sq. ft. divided by 75 = 12 Toddlers
PRESCHOOL PLAYGROUND 109.083 x 60.498 = 6,599.303
70.000 x 23.332 = 1,633.24
8,232.543 minus 191.952 (encumbered space) = 8,040.591 sq. ft - 949.72 sq. ft = 7,090.871 sq. ft
TOTAL OUTDOOR SPACE: 7,090.871 sq. ft. divided by 75 = 94 children.
The request for a decrease in capacity and adding a Toddler Component to the license is approved pending management's final review and approval.
Pending Documents:1: Application 200A, 2: LIC 610 Emergency Disaster Plan
There were no deficiencies cited.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
This report was edited for accuracy (to reflect total number of fixtures) and submitted to licensee for review.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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