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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416176
Report Date: 10/14/2021
Date Signed: 11/02/2021 11:16:21 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:SJB - JAMES LICK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
434416176
ADMINISTRATOR:LINDSAY MASUDAFACILITY TYPE:
830
ADDRESS:57 NORTH WHITE ROADTELEPHONE:
4089285221
CITY:SAN JOSESTATE: CAZIP CODE:
95127
CAPACITY:10CENSUS: DATE:
10/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Patricia Keith TIME COMPLETED:
01:41 PM
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Licensing Program Analysts (LPA), Stephanie Collins, met with Site Director Patricia Keith and Rebecca Larsen and informed them of the nature of the inspection. The licensee requested an increase in capacity via adding square footage to the infant activity room. LPA toured the facility both inside and out as well as measured the space available for the children. Indoor measurements are as follows:
INFANT ROOM:
26.08 x 16. = 417.28 minus 86.57 (encumbered space) = 330.71
16.25 x 8.33= 135.36 =135.36 = 135.36
TOTAL INFANT INDOOR SPACE: 466.07 sq. ft. divided by 35 = 13 children
There is 1 sink (15) available for the children in the infant program. There are 6 cribs, 5 cots, 14 cubbies, 6 chairs, and 1 table.

Only cold is available in the children's sink. There are two staff bathrooms located next to the Infant Room. The sick child will use one of the staff bathrooms if needed and will be accompanied by a staff member. The sick child will be isolated in the Director's Office and isolation equipment will be provided. First Aid supplies are available in the room inaccessible to the children. There is a diaper changing table within arm's reach of a sink in the infant room. The center will be administering medication and medication lock box is stored in the upper cabinet in the classroom. The center will be providing breakfast, lunch, and afternoon snacks for those children who are eating solid food. There is a kitchen located in the classroom for food preparation. The kitchen is equipped with refrigerator, oven, stove, microwave, dishwasher, and a sink with hot and cold running water. Disposable dishes and utensils will be available for the children. Sanitation is by the dishwasher. LPA observed trash cans with tight-fitting lids in the room for the disposal of solid waste. Cleaning products, sharp, objects, and other similar items are stored in the upper cabinet in the classroom. LPA observed at least one functioning carbon monoxide detector at the facility. Site Director states there are no weapons on the premises. Drinking water indoor is via sippy cups and bottles.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
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 2
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: SJB - JAMES LICK CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 434416176
VISIT DATE: 10/14/2021
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Infant /Toddler Option Outdoor Measurements-(Per 06/26/2019 report )
Infant /Toddler Yard: 1/2 (43.250)(30.000) = 648.75
43.250 x 26.583 = 1,149.714
1,798.464 minus 17.920 = 1,780.544

TOTAL TODDLER OPTION OUTDOOR SPACE: 1,780.544 sq ft divided by 75 = 23 children

The toddler option and the children from the infant program will be sharing the Toddler Yard at different times and will not be commingle at any time (waiver on file). Shade in the toddler yard is by canopy and patio. The yard is surrounded with appropriate fencing and the outdoor surfaces are safe. Drinking water outdoor is via individual sippy cups and bottles. The center will not provide transportation for the children. There is a working telephone at the facility which is (408) 928-5240.

Facility will be providing Incidental Medical Services (IMS) and Plan of Operation will be submitted to Licensing.




A license for 12 children in the infant program will be approved pending Managements review and final approval

No deficiencies, exit interview conducted, and a copy of this report was left at the facility.

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

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

DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2021
LIC809 (FAS) - (06/04)
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