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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415781
Report Date: 07/20/2021
Date Signed: 07/20/2021 02:29:26 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:GOOD SHEPHERD CHRISTIAN SCHOOLFACILITY NUMBER:
434415781
ADMINISTRATOR:NGUYEN, SYLVIAFACILITY TYPE:
850
ADDRESS:940 S STELLING ROADTELEPHONE:
(408) 352-5756
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY:56CENSUS: 18DATE:
07/20/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Edward LinTIME COMPLETED:
02:40 PM
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Licensing Program Analysts (LPAs), Marilou Monico and Aman Sharma, met with Program Administrator, Edward Lin, for a case management inspection in response to licensee's request to remove the Toddler Option Program on the license and adding a classroom to the preschool program. LPAs toured the facility both inside and out. The following measurements were taken by LPAs Monico and Estapia on June 12, 2018:

PRESCHOOL ROOM 1 (previously Preschool Room) 45.333 x 33.750 = 1,529.988 minus 87.857 (encumbered space) = 1,442.131
PRESCHOOL ROOM 2 (previously Toddler Option Room) 33.417 x 17.667= 590.378 minus 29.168 (encumbered space) = 561.21
TOTAL PRESCHOOL INDOOR SPACE: 2,003.341 sq. ft. divided by 35 =57 children.

PRESCHOOL OUTDOOR MEASUREMENTS:
PLAYGROUND 1 (previously Preschool Playground) 45.333 x 7.417= 336.234
82.417 x 155.000 = 12,774.635
Playground 1 total = 13,110.869 minus 2,135.581 (encumbered space) = 10,975.288
PLAYGROUND 2 (previously Toddler Option Playground) 44.750 x 22.417 = 1003.160
TOTAL PRESCHOOL OUTDOOR SPACE: 11,978.448 sq ft divided by 75 = 159 children

There are 4 sinks (60) and 3 toilets/1 urinal (60) available for the children. There are 70 chairs, 31 tables, 60 cots, 60 cubbies, and 72 hooks.

The toddler option program will be removed on the license and a classroom (Preschool Room 2) will be added on the preschool program pending the receipt of the following:
1) Approved fire clearance
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: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2021
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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