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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417010
Report Date: 11/19/2021
Date Signed: 11/24/2021 01:36:52 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:NOAH'S ARK CHILDREN LEARNING CENTERFACILITY NUMBER:
434417010
ADMINISTRATOR:CHIAYI LIFACILITY TYPE:
830
ADDRESS:560 HARRISON AVENUETELEPHONE:
(408) 691-3808
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:20CENSUS: 11DATE:
11/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:ChiaYi LiTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Dung Mac conducted an announced follow up Pre-licensing inspection to the facility today. LPA met with ChiaYi Li, Applicant Representative, and Amie Oman, Site Director, and explained the nature of today's inspection.

The initial pre-licensing inspection was completed on November 5, 2021. The Facility is applying for a license for 20 infant children in Rooms 3 & 4. LPA inspected indoor and playground areas with the Applicant Representative. LPA notes that the following items have completed during today’s follow-up inspection.
1) Sandbox was removed.
2) A waiver request along with staggered schedules for shared preschool back
playground space was submitted.
3) AC unit and shed are in off-limit area.
4) Updated outdoor sketches indicating Infant, Toddler, and Preschool
playgrounds were submitted.
5) Infant playground has age appropriate toys and equipment.
6) Changing table in the Toddler bathroom has 3-inch side and changing pad is
one-inch thick.
7) A Waiver request to allow the Toddler children to share the space used
by the Preschool children early in the morning and late in the afternoon was
submitted.

LPA conducted an exit Interview and advised ChiaYi that a license for 20 Infant children will be submitted for the final stage of review by Licensing Management.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Dung MacTELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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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