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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416693
Report Date: 03/08/2023
Date Signed: 03/08/2023 04:41:59 PM

Document Has Been Signed on 03/08/2023 04:41 PM - It Cannot Be Edited

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:LITTLE OAK PRESCHOOLFACILITY NUMBER:
434416693
ADMINISTRATOR:JENNIFER POTMESILFACILITY TYPE:
850
ADDRESS:1921 CLARINDA WAYTELEPHONE:
(408) 396-1252
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 145TOTAL ENROLLED CHILDREN: 98CENSUS: 79DATE:
03/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Jennifer Potmesil & Annie ChouTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Marilou Monico and Farida Raja met with Site Director, Jennifer Potmesil, and Executive Director, Annie Chou, for the purpose of conducting a Case Management Inspection. The facility submitted an application to add Room 32 on the license. Fire clearance was approved on February 1, 2023.

The Preschool Program operates Monday through Friday from 8:00 AM to 5:00 PM, serving children ages 2 years old to entry into first grade. LPAs toured the facility during today's inspection as well measured the space available for the children.

The following are indoor measurements and information:
Room 6: 31.417 x 26.000 = 816.842
1/2 (10.083 x 7.583) = 38.229
1/2 (10.750 x 7.583) = 40.758
1/2 (10.583 x 7.667) = 40.569)
Room 6 total = 936.398 minus 79.652 (encumbered space) = 856.746

Room 7: 31.417 x 26.000 = 816.842
1/2 (10.083 x 7.583) = 38.229
1/2 (10.750 x 7.583) = 40.758
1/2 (10.583 x 7.667) = 40.569)
Room 7 total = 936.398 minus 66.11 (encumbered space) = 870.288


Continuation on Page 2
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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: LITTLE OAK PRESCHOOL
FACILITY NUMBER: 434416693
VISIT DATE: 03/08/2023
NARRATIVE
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Room 22: 42.250 x 42.167 = 1,781.555 minus 669.146 (encumbered space) = 1,112.409
Room 29: 42.250 x 42.167 = 1,781.555 minus 669.146 (encumbered space) = 1,112.409

Room 30: 31.417 x 26.000 = 816.842
1/2 (10.250 x 8.833) = 45.269
1/2 (7.667 x 10.750) = 41.210
1/2 (7.500 x 10.500) = 39.375
Room 30 total = 942.696 minus 84.042 (encumbered space) = 858.654

Room 31: 31.417 x 26.000 = 816.842
1/2 (10.250 x 8.833) = 45.269
1/2 (7.667 x 10.750) = 41.210
1/2 (7.500 x 10.500) = 39.375
Room 31 total = 942.696 minus 84.042 (encumbered space) = 858.654

Room 32: 31.417 x 26.000 = 816.842
1/2 (10.083 x 7.583) = 38.229
1/2 (10.750 x 7.583) = 40.758
1/2 (10.583 x 7.667) = 40.569)
Room 32 total = 936.398 minus 64.239 (encumbered space) = 872.159

Room 33: 31.417 x 24.000 = 754.008
1/2 (10.083 x 7.583) = 38.229
1/2 (10.750 x 7.583) = 40.758
1/2 (10.583 x 7.667) = 40.569
Room 33 total = 873.564 minus 4.668 (encumbered space) = 868.896
TOTAL PRESCHOOL INDOOR SPACE = 6,551.561 sq. ft. divided by 35 = 187 children

Continuation on Page 3
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
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: LITTLE OAK PRESCHOOL
FACILITY NUMBER: 434416693
VISIT DATE: 03/08/2023
NARRATIVE
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The following are outdoor measurements and information:

Playground 1: 145.333 x 111.750 = 16, 240.962

Per report dated 10/15/20 taken by LPA Mac:
Playground 2: (23.6 x 45.2 = 1,066.720) + (45 x 39 = 1,755.000)
+ (21.6 x 12.8 = 276.48) = 3,098.200

Portion of Playground 3: 144.750 x 43.750 = 6,332.812 ( blacktop area)
37.833 x 88.083 = 3,332.444 (tanbark area)
Playground 3 total = 9,667.256
TOTAL PRESCHOOL OUTDOOR SPACE: 29,006.418 sq. ft. divided by 75 sq. ft. = 386 children

LPAs observed the playgrounds are surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by trees, canopies, and building overhang. Drinking water outdoors are provided via pitchers and individual water bottles. LPAs observed tanbanks/sand as resilient material under and around the climbing structures and swings. No bodies of water were observed.

Site Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Exit interview conducted and report was reviewed with Jennifer Potmesil, Site Director . LPAs advised Jennifer that Room 32 is approved to be added in the preschool license effective today, Mach 8, 2023.

There were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
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: LITTLE OAK PRESCHOOL
FACILITY NUMBER: 434416693
VISIT DATE: 03/08/2023
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The facility has 16 sinks (240), 10 toilets (150), and 3 urinals (45) available for the children. The sinks used by children only have cold running water. There are two staff bathrooms at the facility located next to Room 20 in the Office Building. There is a separate bathroom for sick children located in Room 11. Sick children will be isolated in Room 11 and isolation equipment will be provided. Staff and children's bathrooms are clean, sanitary, and operable.

LPAs observed containers with tight-fitting lids for the disposal of solid waste. First aid supplies are stored in each classroom inaccessible to children. Cleaning supplies are stored in the upper cabinet in each room out of reach of children. LPAs observed smoke and carbon monoxide detectors and appropriate lighting in each classroom. The facility has heating and air conditioning. Medications are in a lock box stored in each room inaccessible to children.

Jennifer understands that the facility must be kept free of flies, other insects & rodents. LPAs observed that all furniture and equipment indoors are in good condition and safe for the children. Drinking water is readily available for the children indoors via pitchers and individual water bottles. The facility serves morning and afternoon snacks and are prepared in each room. Parents provide lunch for their children.

There are 30 tables, 160 chairs, 217 cubbies, 144 hooks, 107 cots for the children. Some of the children will be attending on a part time basis and will not nap at the center. There is adequate equipment, supplies, and toys for the preschool children in each classroom.

This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Continuation on Page 4
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4