434417015-1-12-2022-07-CC-DMAC-CALNZ3-20220112095340

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417015
Report Date: 11/30/2021
Date Signed: 01/12/2022 09:53:53 AM

Document Has Been Signed on 01/12/2022 09:53 AM - 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:	SHU REN INTERNATIONAL SCHOOL		FACILITY NUMBER:	434417015
ADMINISTRATOR:	YI QUE		FACILITY TYPE:	850
ADDRESS:	540 SANDS DRIVE, SUITE B		TELEPHONE:	(408) 508-6259
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY: 120	TOTAL ENROLLED CHILDREN: 120	CENSUS: 0	DATE:	11/30/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Charles (Chip) Miller		TIME COMPLETED:	04:40 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 a scheduled Pre-Licensing inspection and met with Charles (Chip) Miller, Applicant and Jing Cai, Site Director. The Applicant is applying for a License to serve 103 children ages 2-6 years old. The Facility is located on the premises of the Church (Church On The Hill). LPA notes that Shu Ren International School and Kids Speaking Spanish Preschool are on the same premise (Kids Speaking Spanish Preschool in building E). The Center will operate Monday through Friday from 7:30AM to 6:00PM. The facility was inspected inside and outside during today’s inspection. INDOOR MEASUREMENTS ARE AS FOLLOWS: Room C1: (32.583 x 24.417) + (14.167 x 7.333) = 899.470 Room C2: (33.667 x 24.250) + (13.833 x 7.083) = 914.400 Room D1: (33.333 x 24.250) + (14.167 x 7.083) = 910.460 Room D2: (33.333 x 24.250) + (14.167 x 7.083) = 910.460 *TOTAL INDOOR ACTIVITY SPACE:* *3,634.78 sq. ft. divided by 35 sq. ft = 103 Preschool children* Facility has 10 sinks (150) and 8 toilets (120) available for children to use. The sinks used by children only have cold running water. Children who become ill will be isolated in the office with isolation equipment. Report To Be Continued on Page #2

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

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: SHU REN INTERNATIONAL SCHOOL	FACILITY NUMBER: 434417015
	VISIT DATE: 11/30/2021

NARRATIVE

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LPA observed a trash can with tight-fitting lid and smoke/carbon monoxide detectors in each classroom. Cleaning supplies will be stored in the off-limit kitchens. First aid supplies are stored in each classroom on high shelves inaccessible to the children. Medications will be stored in each classroom on the high shelf inaccessible to children. Director states that there are no poisons at the facility. LPA did not observe any fireplaces or wall heaters at the Facility. The Facility has central heating/air conditioning in all classrooms. All preschool classrooms have appropriate lighting.

There are 24 tables, 98 chairs, 96 cubbies, and 50 mats for the children. Drinking water is readily available for the children indoors via pitchers/individual bottle of water. Facility will not provide transportation. Center will provide the potty-training.

Chip states that the entire second floor of the facility (Rooms C3, C4, D3, and D4) is off limits to children.

There are 2 kitchens on-site between each 2 classrooms. Food preparation areas are functional and have hot and cold running water, sink, refrigerator, microwave, and storage space for food. Facility will serve only AM and PM snacks. Children will bring their own lunch. Cleaning and sanitation of dishes and utensils will be done via hand washing.

OUTDOOR MEASUREMENTS:

Building A = 64.000 x 50.667 = 3,242.69
Building B = 69.667 x 50.667 = 809.54
Building C = 92.667 x 55.250 = 809.54
Building D = 82.167 x 50.667 = 4,163.16

TOTAL OUTDOOR SPACE = 9,069.03 sq ft divided by 75 = 120 children

Chip states that the playground is exclusively for the facility and is surrounded by appropriate fencing. The areas around and under the play structures are cushioned with material that absorbs falls. Shade is provided by trees and building overhangs. There are adequate equipment, supplies, and toys for children outdoors. LPA observed barricaded stairs leading to the second floor in the playground. Drinking water will be provided outdoors via pitchers/individual bottle of water. No bodies of water and storages/sheds were observed.

Report To Be Continued on Page #3

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

LIC809 (FAS) - (06/04)

Page: 3 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: SHU REN INTERNATIONAL SCHOOL	FACILITY NUMBER: 434417015
	VISIT DATE: 11/30/2021

NARRATIVE

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LPA reminded Applicant 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, a 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.

Charles Miller, Applicant Representative, and Jing Cai, Director, have obtained a Criminal Records Clearance and Child Abuse Index Checks. Director has met the education and experience qualification requirements. Site Director is enrolled in Pediatric First Aid/CPR and a proof of registration is on file. Director has proof of completion of Preventative Health Practices and proof of immunity against Measles and Pertussis, Influenza on file.

LPA conducted an exit Interview and advised Jing Cai that a license for 103 Preschool children will be submitted for the final stage of review by Licensing Management upon receiving of the following documents:
1) A photo of barricaded wall above the sandbox.

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021

LIC809 (FAS) - (06/04)

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