434416239-1-28-2020-07-CC-MSMS-BL9RJZ-20200128120447

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416239
Report Date: 01/28/2020
Date Signed: 01/28/2020 12:04:56 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:	SAFARI KID - EVERGREEN FOWLER		FACILITY NUMBER:	434416239
ADMINISTRATOR:	NEENA BILLIMORIA		FACILITY TYPE:	850
ADDRESS:	3122 FOWLER ROAD		TELEPHONE:	(408) 600-6031
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	60	CENSUS:	DATE:	01/28/2020
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Jaishree Chitkara		TIME COMPLETED:	12:15 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 Analyst (LPA) Mel Matos conducted an announced prelicensing inspection at the Facility today. LPA met with Jaishree Chitkara, Applicant Representative, and explained the nature of today's inspection to her. The Applicant Representative has submitted an Application for a preschool license as a result of a change of ownership. The Facility is currently licensed and operating as Evergreen Montessori School (#434408043). The current ownership has submitted paperwork to CCL advising of the sale of the Facility/property and of closure of the current facility license as of January 31, 2020. LPA toured and measured the indoor and outdoor areas of the Facility during today's inspection. INDOOR MEASUREMENTS ARE AS FOLLOWS: Valley Oak Room: 36.917 x 10.500 = 387.628 Sequoia Room: (19.833 x 17.000) + (23.000 x 19.000) = 774.161 Redwood Room: 31.083 x 31.000 = 963.573 *TOTAL INDOOR SPACE: 2,125.362 sq. ft. divided by 35 = 60 preschool children* There are 6 toilets (90) and 7 sinks (105) available for the preschool children within the Facility. Potty training will be provided by the Facility. There is no hot water available in the children's sinks. Staff have a separate staff bathroom that can be utilized by sick children if necessary. Sick children will be isolated in the front lobby area of the Facility and isolation equipment will be provided. The Facility will utilize the 3 step method of soap/bleach/water & commercial products for disinfecting purposes. There are separate staff sinks (2) with hot/cold running water within the Facility for staff use. REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 01/28/2020):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020

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: SAFARI KID - EVERGREEN FOWLER	FACILITY NUMBER: 434416239
	VISIT DATE: 01/28/2020

NARRATIVE

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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 01/28/2020):

LPA did not observe any fireplaces or wall heaters at the Facility. The Facility has central heating/air conditioning in each Room. All preschool classrooms have appropriate lighting. First aid supplies are stored in each Classroom inaccessible to the children. The Director has the full 15 hours of Health and Safety Training. Jaishree provided LPA with the director paperwork for Varsha Kumar, new director, during today's inspection. Medications will be stored in an appropriate lock box in the front lobby/director's office area inaccessible to children.

The food preparation area (kitchen) is functional and has hot and cold running water, sink, refrigerator, microwave, oven, and storage space for food. The Facility will provide snacks (morning and afternoon) and lunch for the preschool children. Cleaning and sanitation of reusable dishes and serving utensils will be done via hand washing/dishwasher. Disposable utensils and plates will be utilized by the Facility. LPA observed a solid waste container with a tight-fitting lid in each Room. Cleaning supplies will be stored on high shelves & in each Room & locked storage areas inaccessible to children.

There are 60 chairs, 23 tables, 60 hooks/hanging space, 59 cots, and 2 mats for the preschool children. There is adequate equipment, supplies and toys for the preschool children in each Room. Drinking water will be provided indoors via pitchers/disposable cups of water. There is a working telephone at the Facility. The phone number is 408-600-6031.

OUTDOOR MEASUREMENTS ARE AS FOLLOWS:

Parking & Play Area: 59.417 x 44.750 = 2,658.910
Large Play Area: (31.167 x 51.250) + (46.500 x 43.500) = 3,620.058
Small Play Area: 50.000 x 22.250 = 1,112.500

TOTAL OUTDOOR SPACE: 7,391.468 sq. ft. divided by 75 = 211 children.

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 01/28/2020):

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020

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: SAFARI KID - EVERGREEN FOWLER	FACILITY NUMBER: 434416239
	VISIT DATE: 01/28/2020

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CONTINUATION OF PREVIOUS PAGE (PAGE #3 - REPORT DATED 01/28/2020):

LPA observed that preschool playgrounds are surrounded by appropriate fencing. The playground equipment is age appropriate and rubbing padding is used as resilient materials. Shade will be provided by trees, canopies, and building overhangs throughout all three playground areas. There are adequate equipment, supplies, and toys for children outdoors. LPA did not observe any bodies of water during today's inspection. Transportation will not be provided by the Facility.

LPA received a fire clearance approval from the San Jose Fire Department for 60 preschool children prior to today's inspection.

A review of staff records on January 28, 2020 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Jaishree of the applicable $100 civil penalty per person per day, a minimum of $100.00 to a maximum of $3000.00 per person for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children.

LPAs conducted an exit interview with Jaishree prior to the conclusion of today's inspection and advised them that a license for 60 preschool children will be approved effective Monday February 3, 2020.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020

LIC809 (FAS) - (06/04)

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