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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415223
Report Date: 02/24/2023
Date Signed: 02/24/2023 11:19:45 AM

Document Has Been Signed on 02/24/2023 11:19 AM - 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:CALIFORNIA YOUNG WORLD AT ELLISFACILITY NUMBER:
434415223
ADMINISTRATOR:JOSEPHINE FELIXFACILITY TYPE:
850
ADDRESS:550 EAST OLIVE AVENUETELEPHONE:
(408) 774-0405
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 24TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/24/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nora LacayoTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA), Mel Matos, conducted an announced follow up case management inspection to the Facility today in response to a request received by the Department to drop Portables A & B from the existing license and add Room P-10 to the preschool license. LPA met with Nora Lacayo, director, and explained the nature of today's inspection to her. The Facility is located on the campus of Ellis Elementary School. The licensed capacity remains unchanged (24 preschool children). Hours of operation: 8:30 AM to 11:30 AM - Monday to Friday during the calendar school year for the Sunnyvale School District. A fire clearance approval from Sunnyvale Department of Public Safety was received by LPA prior to today's inspection. Measurements of the Indoor & Outdoor space were taken by LPAs Matos and Cruz on February 14, 2023 and are noted below.

Indoor measurements:

Room P-10: 39.000 x 32.000 = 1,248.000
Total indoor space: 1,248.000 divided by 35 = 35 preschool children

Outdoor measurements:

134.000 x 113.000 = 15,142.000
Total outdoor space: 15,142.000 divided by 75 = 201 preschool children

LPA reminded Nora that all required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule must be posted in Room P-10.

There are sufficient tables, chairs, and cubbies/hooks for the children in Room P-10. There is sufficient equipment and supplies for the school age children in both rooms. LPA observed solid waste containers with tight-fitting lids in Room P-10. Staff and children's bathrooms are clean, sanitary, and operable.

LPA notes that the kitchen/food prep area is located in Room P-10. Drinking water will be provided via drinking fountains & water jugs cups/water bottles indoors and outdoors. Preschool children will use the playground area, located behind Room P-10. There is a climbing structure in the outdoor area that is safe/secure and age appropriate. There is sufficient materials for outdoor use for the school age children. Resilient materials are sufficient underneath and surrounding the play structure. Shade is provided by building overhangs.

LPA conducted an exit interview with Nora prior to the conclusion of today's inspection and advised her that a license for 24 preschool children in Room P-10 is approved effective today, February 24, 2023.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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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