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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417020
Report Date: 02/22/2022
Date Signed: 02/22/2022 03:04:25 PM

Document Has Been Signed on 02/22/2022 03:04 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: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:
02/22/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Adlin NettoTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Dung Mac conducted the 2nd announced follow up Pre-licensing inspection to the facility today. LPA met with the Applicant/Site Director, Adlin Netto.

The Applicant/Site Director was advised during the 1st follow-up inspection of the following items that needed to be completed prior to the 2nd follow-up inspection.
) Two ceiling panels in Room 1 have water stains and need to be replaced.
2) Kitchen area needs to be clean and fully operational, including sufficient food inventory.
3) The toilet tank in one of children's bathrooms is cracked/not stable and needs to be replaced.
4) Sufficient tables, chairs, cubbies, and materials for 45 children (requested capacity) need to be present in the Facility.
5) Staff bathroom and classrooms need to be labeled.
6) Daily schedules reflecting staggered usage of indoor activity area need to be submitted.
7) Entire Facility flooring and walls need to cleaned and free of dust/debris.
8) Wall thermostat is not functional.
9) Plastic film covering on ceiling lights needs to be removed.
10) Children's sinks have hot water (less than 120 degrees F).

LPA inspected the entire indoor areas of the Facility, including the kitchen, with the Applicant during today's inspection. The following items were observed/completed during today's inspection.
1) Two ceiling panels in Room 1 that had water stains were replaced.
2) Kitchen area is clean and fully operational, including sufficient food inventory.
3) The toilet tank in one of children's bathrooms was replaced.
4) Copies of the invoices for tables, chairs, cubbies, and materials were received prior today's inspection.
5) Staff bathroom and classrooms were labeled.
6) Daily schedules reflecting staggered usage of indoor activity area were received prior to today's inspection.
7) The entire facility flooring and walls is clean and free of dust/debris.
8) Wall thermostats are functional.
9) Plastic film covering on ceiling lights was removed.
10) Children's sinks have hot water (less than 120 degrees F).

LPA conducted an exit Interview and advised Adlin that a license for 45 preschool children will be granted pending Licensing Management review and approval.
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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