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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417020
Report Date: 01/18/2022
Date Signed: 01/20/2022 09:45:23 AM

Document Has Been Signed on 01/20/2022 09:45 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:AGAPE PLAYSKOOLFACILITY NUMBER:
434417020
ADMINISTRATOR:ADLIN SOFIA NETTOFACILITY TYPE:
850
ADDRESS:181 EAST TASMAN DRIVE #70TELEPHONE:
(669) 295-8697
CITY:SAN JOSESTATE: CAZIP CODE:
95134
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 0DATE:
01/18/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Adlin NettoTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA), Dung Mac, conducted an announced pre-licensing visit to the Facility today. LPA met with Adlin Netto, Applicant Representative/Site Director, and explained the nature of today's visit. The facility is located on the first floor of a complex apartment and retail shop.

The facility will operate Monday through from 8:45 AM to 12:00PM Monday to Friday, serving preschool children ages 2-5 years old.

LPA toured and measured the indoor of the Facility during today's visit.

INDOOR MEASUREMENTS ARE AS FOLLOWS:

Classroom 1
(16.417 x 21.667) minus encumbered (1.667 x 2.833)
= 355.707 - 4.722 = 350.985

Classroom 2
22.167 x 16.333 = 362.053

Classroom 3 / Activity Area
(48.833 x 42.833 + 7.500 x 22.917) minus encumbered (6.750 x 16.417)
= 2,263.540 - 110.814 = 2,152.726

TOTAL INDOOR SPACE
2,865.764 sq. ft. divided by 60 sq. ft/child = 47 preschool children


Report To Be Continued on Page #2
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 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: AGAPE PLAYSKOOL
FACILITY NUMBER: 434417020
VISIT DATE: 01/18/2022
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There is 3 toilets (45) and 3 sinks (45) available for the preschool children. Adlin states that children's sinks has both hot and cold running water; however, there is no hot water. LPA observed dispenser soap and disposable towels in the 3 bathrooms. Staff have a separate bathrooms that can be utilized by sick children if necessary. Sick children will be isolated in the director's office and isolation equipment is provided.

LPA observed solid waste containers with tight-fitting lids in each classroom. Cleaning supplies will be stored in off-limit storage areas inaccessible to children. The Facility will not administer any medications to the children. First aid supplies will be stored in the reception area inaccessible to the children. The Facility will not be providing any transportation.

There are 30 chairs, 3 tables, and 36 cubbies. There is adequate equipment, supplies, and toys for the preschool children in each room. Drinking water will be provided via individual bottle and drinking fountains with filter. The facility will only provide snacks for the preschool children since it will not be a full day program. The food preparation area has a refrigerator and a sink, however, the kitchen has not been set up yet.

The Facility has no outdoor space and uses Room 3 as a multipurpose area for gross motor activities. A waiver request for the lack of outdoor space was submitted to LPA prior to today's visit. Adlin understands that the maximum licensed capacity the Department can grant will be 47 preschool children since 60 square feet per child is required to compensate for the lack of outdoor space.

Adlin Netto, Applicant Representative/Site Director, has obtained a Criminal Records Clearance and Child Abuse Index Checks. Director has met the education and experience qualification requirements. Director's Pediatric First Aid/CPR Certifications expires in 1/11/2024. Director has proof of completion of Preventative Health Practices and proof of immunity against Measles and Pertussis, Influenza on file.

Report To Be Continue on Page #3
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
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: AGAPE PLAYSKOOL
FACILITY NUMBER: 434417020
VISIT DATE: 01/18/2022
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LPA reminded Adlin 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.

LPA conducted an exit interview and advised Adlin of the following items that needed to be completed and a follow-up inspection will be conducted.
1) Kitchen needs to be fully setup.
2) Hot water in children's sinks.
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
LIC809 (FAS) - (06/04)
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