434417010-11-9-2021-07-CC-DMAC-C8LQBF-20211109110128

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417010
Report Date: 11/05/2021
Date Signed: 11/09/2021 11:02:04 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:	NOAH'S ARK CHILDREN LEARNING CENTER		FACILITY NUMBER:	434417010
ADMINISTRATOR:	CHIAYI LI		FACILITY TYPE:	830
ADDRESS:	560 HARRISON AVENUE		TELEPHONE:	(408) 691-3808
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	20	CENSUS: 15	DATE:	11/05/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ChiaYi Li		TIME COMPLETED:	05:00 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 Analysts (LPAs) Dung Mac and Mel Matos, conducted an announced pre-licensing inspection (change of ownership) to the Facility today. LPAs met with ChiaYi Li, Applicant Representative, and Amie Oman, Site Director, and explained the nature of today's inspection to them. The Facility is still in operation (Facility #434407954) pending the approval of the change of ownership. Note: Applicant representative has applied for a Infant with Toddler Option (#434417010) and Preschool (#434417009) on the same premises. The Infant Center will operate Monday through Friday from 8:00AM-5:00PM, serving Infant children ages birth to 24 months and Toddler children ages 24 months-36 months. The Infant program will be utilizing Rooms 3 (Toddler Room) & 4 (Infant Room) and the Preschool program will be using Rooms 1 & 2. A fire clearance approval from the Seaside Fire Department for 20 Infant children was received prior to today's inspection. LPAs toured and measured the indoor and outdoor areas of the facility during today's inspection. INDOOR MEASUREMENTS ARE AS FOLLOWS: Room 4 (Infant Room) 27.667 x 10.667 = 295.12 Encumbered = (3.917 x 2.000) + (2.917 x 1.167) + (2.500 x 1.583) = 15.195 295.12 minus 15.195 (encumbered) = 279.920 11.667 x 9.167 = 106.950 Encumbered = (11.000 x 1.583) + (2.000 x 2.250) + (4.167 x 1.000) = 26.08 106.950 minus 26.080 (encumbered) = 80.870 Room 4 Total = 279.920 + 80.870 = *360.80* Report To Be Continued on Page #2

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

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: NOAH'S ARK CHILDREN LEARNING CENTER	FACILITY NUMBER: 434417010
	VISIT DATE: 11/05/2021

NARRATIVE

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Room 3 (Toddler Room)
19.750 x 17.417 = 343.985

TOTAL INFANT INDOOR SPACE = 704.78 sq. ft. divided by 35 = 20 children

The Infant Room has a refrigerator, microwave, and bottle warmers. There are highchairs as infant children will be held while feeding until they are able to sit unassisted in a chair. Feeding chairs and other appropriate seating equipment will be used to seat infants during feeding. ChiaYi understands that propped bottles are not permitted. Infants shall be held during feedings if they are unable to sit unassisted. ChiaYi understands that the Needs and Service Plan needs to be updated at least once every 3 months. A baby walker or any similar items shall not be used on the premise of a child day care facility.

Sleeping area is separate from the indoor activity space. Facility has 4 cribs, 4 high chairs, 2 feeding chairs, 7 mats for younger infants, and 12 cots for toddler children. ChiaYi understands that cribs shall be arranged to provide a walkway between cribs to allow staff to reach each infant without having to reach over any other infant. ChiaYi understands that each infant's bedding shall be used for him/her only and such bedding shall be replaced when wet or soiled. ChiaYi also understands that the infants must be under direct visual supervision at all times, including nap times, in the separate sleeping (crib) area.

There is an appropriate changing table that has raised side (3 inches in height) and is within an arm's reach of a sink in the Infant Room. LPAs observed containers with tight-fitting lids for solid waste and diaper disposable.

There are 3 tables, 12 chairs, and 24 cubbies. Facility has appropriate lighting in both classrooms. Functioning smoke/carbon monoxide detectors were observed. Facility has adequate toys and activities for children. LPAs did not observe any wall heaters at the Facility. Medications will be stored in Room 4 and in the kitchen on high shelves inaccessible to children. First aid supplies (including touch less thermometer) and cleaning supplies are stored on high shelves inaccessible to children.

Report To Be Continued on Page # 3

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

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: NOAH'S ARK CHILDREN LEARNING CENTER	FACILITY NUMBER: 434417010
	VISIT DATE: 11/05/2021

NARRATIVE

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There are 2 sinks (30) and 1 toilet available for children to use. The sinks used by children only have cold running water. ChiaYi states that the Infant program will offer potty training. Drinking water is readily available for the children both indoors and outdoors via individual water bottles/filtered water. Transportation will not be provided by the Facility.

Staff bathroom is clean and sanitary and can be utilized by sick children if necessary. Sick children will be isolated in the director's office and isolation equipment will be provided. ChiaYi states that there are no weapons or firearms on the premises.

Parents will provide formulas, baby food, diapers for young infant children. Facility will provide breakfast, lunch, and AM/PM snacks for older infant and toddler children. There is an off-limits kitchen for food preparation. The food preparation area (kitchen) is functional and has hot and cold running water, sink, refrigerator, stove, and storage spaces for food. Cleaning and sanitation of dishes and utensils will be done via hand washing.

OUTDOOR MEASUREMENTS ARE AS FOLLOWS:

Infant playground = 32.667 x 18.417 = 600.08 sp.ft

TOTAL OUTDOOR SPACE = 600.08 sq. ft. divided by 75 = 8 infant children

LPAs observed the playground is surrounded by appropriate fencing. Shade is provided by patio covering. A locked shed and an uncovered AC unit were observed. ChiaYi states that Toddler Option and Preschool Program will share preschool's back playground, but at different time intervals. No bodies of water were observed.

ChiaYi Li, Applicant Representative, and Amie Oman, Director, have obtained a Criminal Records Clearance and Child Abuse Index Checks. Director has met the education and experience qualification requirements and her Pediatric First Aid/CPR Certifications expire 9/2023. Director has proof of completion of Preventative Health Practices and proof of immunity against Measles and Pertussis, Influenza on file.

Report To Be Continued on Page # 4

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

LIC809 (FAS) - (06/04)

Page: 3 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: NOAH'S ARK CHILDREN LEARNING CENTER	FACILITY NUMBER: 434417010
	VISIT DATE: 11/05/2021

NARRATIVE

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Safe Sleep Regulations were discussed. ChiaYi was provided with a copy of the Safe Sleep Regulations (PIN 20-24-CCP).

LPAs reminded ChiaYi Li of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the facility, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person up to $3000.00 per person.

Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.

LPAs conducted an exit Interview and advised ChiaYi that a license for 20 Infant children will be submitted to Licensing Management for the final stage of approval upon receiving of the following:
1) Remove the sandbox and the shed and submit the photos of Infant playground.
2) A Waiver request along with staggered schedules for shared preschool back playground space.
3) Submit the photos of covered AC unit.
4) Updated outdoor sketch indicating Infant, Toddler, and Preschool playgrounds.
5) Age appropriate toys and equipment for Infant playground.
6) Changing table in the Toddler bathroom must have at least 3-inch side and changing pad must be at least one-inch thick.
7) A Waiver request to allow the Infant/Toddler children to share the space used by the Preschool children early in the morning and late in the afternoon

SUPERVISOR'S NAME: Sandy Knight	TELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

LIC809 (FAS) - (06/04)

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