434416239-2-23-2021-07-CC-DMAC-BYHQQH-20210223112219

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416239
Report Date: 02/02/2021
Date Signed: 02/23/2021 11:22:26 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:	SAFARI KID - EVERGREEN FOWLER		FACILITY NUMBER:	434416239
ADMINISTRATOR:	PALLAVI SATPATHY		FACILITY TYPE:	850
ADDRESS:	3122 FOWLER ROAD		TELEPHONE:	(408) 600-6031
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	60	CENSUS: 0	DATE:	02/02/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jaishree Chitkara		TIME COMPLETED:	03:00 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 Analyst (LPA) Dung Mac conducted an announced case-management tele-inspection via video conference call (FaceTime) with Jaishree Chitkara, the Applicant, in response to Facility’s request to add 12 Toddlers (ages 18-36 months) to the existing Preschool license. The capacity remains unchanged. The preschool program is currently licensed in Rooms: Valley Oak Room, Sequoia Room, And Redwood Room. The facility has requested to split the Sequoia Room into Sequoia Room 1 (Toddler option) and Sequoia Room 2 (Preschool) divided by a 4 feet tall partition. The fire inspection has been granted on 01/7/2021. Jaishree understands that the toddlers and preschool children cannot be commingled at any time. During today's video conference call, Sequoia Room 1 and Sequoia 2 were measured by Jaishree and Pallavi Satpathy, Site Director, as LPA observed the process and provide direction over the video call. There are 5 toilets (75) and 8 sinks (120) available for the children to use. Potty training will be provided by the Facility. Jaishree states that there is only cold water available in children's sinks. LPA observed dispenser soap and disposable towels in the bathrooms. Staff have a separate staff bathroom that can be utilized by sick children if necessary. Children who become ill will be isolated in the Director's Office with isolation equipment. LPA observed smoke detector and carbon monoxide in classrooms. LPA observed First Aid supplies and cleaning products are stored inaccessible to children. LPA observed a solid waste container with a tight-fitting lid in classrooms. Jaishree states that medications are stored in a locked cabinet in Director's office. *Report To Be Continued on Page #2*

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

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: SAFARI KID - EVERGREEN FOWLER	FACILITY NUMBER: 434416239
	VISIT DATE: 02/02/2021

NARRATIVE

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Jaishree states that there were no changes to the layouts of Valley Oak Room and Redwood Room since the Pre-licensing inspection on 1/28/2020; therefore, Valley Oak Room and Redwood Room were not measured during today's tele-inspection.

Indoor Activity Space:

Toddler Room (Sequoia 1): 22.000 x 19.417 = 427.174

TOTAL TODDLER INDOOR SQUARE FOOTAGE:
427.174 sq. ft. divided by 35 sq. ft / child = 12 toddlers

Preschool Rooms:
Sequoia Room 2: 20.667 x 17.167 = 354.790
Valley Oak Room: 36.917 x 10.500 = 387.628
Redwood Room: 31.083 x 31.000 = 963.573

TOTAL PRESCHOOL INDOOR SPACE:
1,705.991sq. ft. divided by 35 = 48 preschool children

LPA observed the food preparation area has a refrigerator, microwave, dishwasher, and storage space for food. Jaishree states that the Facility will provide lunch and AM/PM snacks. Jaishree states that disposable utensils and plates will be utilized by the facility.

There are 60 chairs, 23 tables, 60 hooks/hanging space, and 60 cots for children. Drinking water are provided indoors/outdoors via pitchers/disposable cups of water. Transportation are not provided by the facility.

Jaishree states that there were no changes to the layouts of playground since the Pre-licensing inspection on 1/28/2020; therefore, playground was not measured during today's tele-inspection.

Report To Be Continued on Page #3

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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: 02/02/2021

NARRATIVE

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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

LPA observed that the playground is surrounded by appropriate fencing and a locked large shed. The playground equipment is age appropriate and rubbing padding is used as resilient materials. Shades are provided by trees and building overhangs. LPA did not observe any bodies of water during today's inspection. Jaishree states that Toddler Option and Preschool Program will share the Preschool playground, but at different time intervals. Waiver request and playground schedules for the Toddler Option to share the Preschool Yard have been submitted.

LPA advised Jaishree that due to the COVID-19 pandemic and "shelter in place" order, today's report will be emailed to her (email: jchitkara@gmail.com). Jaishree understands that her reply to the email will serve as acknowledgement that the report was received.

LPA conducted an exit interview and advised Jaishree that facility’s request will be submitted to Licensing Management for the final stage of approval.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

LIC809 (FAS) - (06/04)

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