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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415740
Report Date: 10/18/2019
Date Signed: 10/18/2019 01:43:10 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:SPRINGBRIDGE INTERNATIONAL SCHOOLFACILITY NUMBER:
434415740
ADMINISTRATOR:REGAN, ROBERTFACILITY TYPE:
850
ADDRESS:1625 WEST CAMPBELL AVENUETELEPHONE:
(408) 477-5922
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:48CENSUS: 34DATE:
10/18/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Tomoko ReganTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stephanie Rangel conducted a case management- licensee initiated inspection and met with teacher, Tomoko Regan. LPA arrived today in response to Facility's request to remove the following rooms that are located on the 2nd floor of the building: PS Rooms 12, 11, 10, 9, and 8 from use. The facility is also currently licensed in PS Rooms 1, 2, 3, 4 and 5. The facility has also asked for PS Rooms 6 and 7, that will be used as preschool instructional classroom space, to be added to the license. The preschool has renamed the rooms from "Preschool Room" to "PS Room". LPA toured the indoor and outdoor areas of the facility today.

The following measurements were taken during today's inspection:
PS Room 1: 27.500 X 22.833 = 627.908
PS Room 2: 31.167 X 19 = 592.173 minus 2 (encumbered space) = 590.173
PS Room 3: 19.500 X 30.333 = 592.100 minus 27.251(encumbered space) = 564.849
PS Room 4: 5.500 X 5.667 + 4.333 X 4.083 + 1.500 X 3.750 + 4.250 X 3.750 + 26.583 X 22.333 + 12.167 X 5.833 = 735.059 minus 104.956 (encumbered space) = 630.103
PS Room 5: 22.333 X 21.083 = 479.847 minus 32.801 (encumbered space) = 447.046

The following measurements were taken 7/25/19 by LPA Rangel:
PS Room 6: 17.583 x 12.917 = 227.120 minus encumbered space .625 = 226.495
PS Room 7: 17.667 x 12.083 = 213.470
TOTAL INDOOR SPACE 3,300.044 SQ. FT. DIVIDED BY 35 = 94 CHILDREN.

Report continues on the following page:
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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 4
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: SPRINGBRIDGE INTERNATIONAL SCHOOL
FACILITY NUMBER: 434415740
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2019
Section Cited

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Criminal Record Clearances: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:Request a transfer of a criminal record clearance as specified in Section 101170(f)
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This requirement was not met as evidenced by a staff member not having fingerprint clearance. Facility could not produce evidence of intent to meet this requirement via proof of fingerprint clearance. Staff has been present in the classroom for more than 30 days. This poses an immediate risk to the Health, Safety or Personal Rights to children in care.
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AB 633
Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2019
LIC809 (FAS) - (06/04)
Page: 3 of 4
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: SPRINGBRIDGE INTERNATIONAL SCHOOL
FACILITY NUMBER: 434415740
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/25/2019
Section Cited

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Teacher-Child Ratio: There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.
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This requirement was not met as evidenced by LPA viewing 14 children with one staff in PS 2 and 13 children with one staff in PS 1. This poses a potential risk Health, Safety Personal Rights risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2019
LIC809 (FAS) - (06/04)
Page: 4 of 4
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: SPRINGBRIDGE INTERNATIONAL SCHOOL
FACILITY NUMBER: 434415740
VISIT DATE: 10/18/2019
NARRATIVE
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Report Continues from the Following Page:

The Facility is currently not asking for an increase of capacity from 48 children but, to be able to use the additional rooms and for the rooms to to be added to their license.

Outdoor space at the facility will remain the same.

Fire clearance from the Santa Clara Co. Fire Department was granted on 9/30/19. Use of room 6 and 7 will be approved upon management's approval.

As a result of this inspection, deficiencies cited. Periodic information releases accessible by signing up at: www.myccl.ca.gov. Appeal rights printed and reviewed. $1,500 civil penalty assessed today.

Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction Due Date may result in assessment of civil penalties in the amount of $100 per day per violation until the correction is made.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Stephanie C RangelTELEPHONE: (408) 334-8556
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4