434416392-9-17-2019-07-CC-MBED-BG4NY6-20190917105214

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416392
Report Date: 09/17/2019
Date Signed: 09/17/2019 10:52:19 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:	STIPE CDI		FACILITY NUMBER:	434416392
ADMINISTRATOR:	QUY NGUYEN		FACILITY TYPE:	850
ADDRESS:	5000 LYNG DRIVE		TELEPHONE:	(408) 556-7300
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	48	CENSUS: 0	DATE:	09/17/2019
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Jodi Delfino		TIME COMPLETED:	11:05 AM

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	LPA Mahvash Behbood met with Applicant representative, Jodi Delfino, for a pre-licensing visit on 09/17/19. Facility is located on Stipe Elementary School premises in rooms 152 A ad 152B. Analyst measured both room and the play area. Measurements are as follows: TOTAL SPACE MEASURED: ROOM 152A (8,417 X 11.250=103.108) + (23 X 30.583 =703.409) minus (encumbered) 98.61= 707.898 SQ. FT. ROOM 152B (11,333 X 13.083 = 148.269) + (27.167 X 23.417 = 636.169) = 784.438 SQ. FT. ROOM 152A (707.898) + ROOM 152B (784.438) = 1492.336 SQ. FT. *TOTAL INDOOR SPACE* *1492.336 SQ. FT., DIVIDED BY 35 = 42 CHILDREN.* OUTDOOR SPACE MEASURED: (47.417 x 50.167 = 2,378.768) + (36 x 33.500 = 1206) + (22 x 14 + 308) = 3,892.768 TOTAL OUTDOOR SPACE: 3,892.768 SQ. FT., DIVIDED BY 75 = 51 children. INDOOR INFORMATION: There are toilets ( 3 x 15= 45) and 4 sinks (4 x 15=60 ) available for the children. The lighting and ventilation are adequate. There are 66 chairs and 6 large tables and 36 cubbies. Sick children will be isolated in the office and isolation equipment is provided. The sick child will utilize the staff bathroom.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash Behbood	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

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: STIPE CDI	FACILITY NUMBER: 434416392
	VISIT DATE: 09/17/2019

NARRATIVE

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There is an emergency back pack in each classroom.. Drinking water is provided by water fountain in one classroom and water container and cups in room 152B and the yard. Meals and snacks will be provided by facility. Meals and snacks will be prepared in the kitchen area in classroom B which is equipped with refrigerator, oven, sink, microwave oven, dishes, cups, utensils.
Medication will be stored in medication box inaccessible to children.
An updated LIC 200 was submitted to analyst to reflect the correct capacity request of 42.
A License to operate a preschool for the capacity of 42 is approved pending receiving the yard sketch, and receipt of purchased playground equipment.

SUPERVISOR'S NAME: Anthony Studebaker	TELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash Behbood	TELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2019

LIC809 (FAS) - (06/04)

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