434415758-8-25-2021-07-CC-AMOS-C68Q64-20210825115252

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434415758
Report Date: 08/25/2021
Date Signed: 08/25/2021 11:52:58 AM

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:	SUTTER DISTRICT PRESCHOOL		FACILITY NUMBER:	434415758
ADMINISTRATOR:	JOY BARTOL		FACILITY TYPE:	850
ADDRESS:	3200 FORBES AVENUE, ROOM 21		TELEPHONE:	(408) 423-4237
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY:	24	CENSUS: 0	DATE:	08/25/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Judie Stevens		TIME COMPLETED:	12:00 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 Analysts (LPA's) Anna Morales and Oscar Huang conducted a Scheduled Case Management Visit and were greeted by Anita E.V. Kinney, Program Specialist Family Child Education, Santa Clara Unified School District and Site Supervisor Judie Stevens. The Facility is currently licensed on the campus on Sutter Elementary School in Room 21. The facility has submitted a request to relocate from Room 21 to Room 24. LPA's took measurements of Room 24 and the new playground during today's visit. A Fire Clearance was received from the Santa Clara Fire Department July 27, 2021. The indoor and outdoor playground area measurement are as followed: Classroom areas, ROOM 24 =(Total sq. ft)- (Total Encumbered Space) 39x 22.833=890.487 sq ft - 107.22=783.267 890.487- 107.267= 783.267 divided by 35 = 22 Total Indoor Activity Space (783,267 sq ft) divided by 35 sq ft= 22 children. Outdoor Playground area =(Total sq. ft)- (Total Encumbered Space) 12 929.43-196.961=12,732.469 Total Outdoor Activity Space= 12,732.469 divided by 75= 169 children Continue on page 2

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

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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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: SUTTER DISTRICT PRESCHOOL	FACILITY NUMBER: 434415758
	VISIT DATE: 08/25/2021

NARRATIVE

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The classroom has one sink. There are cubbies for each of the children's personal belongings. LPA's observed age appropriate furnishings. The trash bins have tight fitted lids. All of the disinfectants and toxic materials are stored inaccessible to the children. Observed a fully charged 2A; 10BC fire extinguisher. in the front area of the classroom. The Carbon monoxide is interconnected with the Emergency Fire Alarm. LPA's were informed that the parents use a electronic sign/sign out. 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), and Activity Schedules is posted on a poster board which the parents will be able to observe when dropping off children. The students will be using the bathrooms that are located across the playground. Staff bathrooms are located in the school office.

LPA's observed a secured fenced playground Shade is equipped by a canopy. Age appropriate play structure is equipped with resilient material. Children will be using their own water bottles and the school has refillable water station available.

This facility is licensed through Santa Clara Unified school District and all staff are fingerprinted through School District.

The Request Capacity for Room 24 measured for a total of 22 students. Applicant has submitted a new LIC200 (APPLICATION) during this visit for the capacity of 22.

Approval pending on Final review pending on final review.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE OF THE ROOM, AND MUST REMAIN POSTED FOR 30 DAYS.

No deficiencies cited during today's visit.

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Anna Morales	TELEPHONE: (408) 334-8325
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

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