434417026-4-14-2022-07-CC-DMAC-CDGLP9-20220414085533

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417026
Report Date: 04/13/2022
Date Signed: 04/14/2022 08:55:58 AM

Document Has Been Signed on 04/14/2022 08:55 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:	PRIMROSE SCHOOL OF CUPERTINO		FACILITY NUMBER:	434417026
ADMINISTRATOR:	MONICA THOMPSON		FACILITY TYPE:	830
ADDRESS:	1002 SOUTH DE ANZA BOULEVARD		TELEPHONE:	(408) 685-7133
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	24	CENSUS: 0	DATE:	04/13/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	04:24 PM
MET WITH:	Simaben Shah		TIME COMPLETED:	07:00 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) Stephanie Collins and Dung Mac conducted an announced pre-licensing inspection to the Facility today. LPAs met with Simaben Shah, Applicant/Applicant Representative, and Monica Thompson, Site Director. The applicants are applying for a combination center (Preschool #434417025 and Infant #434417026) on the same premises. The Infant Center will operate Monday through Friday from 7:00AM-6:30PM, serving Infant children ages 12 months-24 months. The Infant program will be utilizing Rooms B1 (Older Infant) and B2 (Toddler). The Preschool program will be using Rooms EP1 (EPS 1), EP2 (EPS 2), C1 (Preschool 1), C2 (Preschool 2), D1 (Pre-Kindergarten 1), and D2 (Pre-Kindergarten 2). LPAs toured and measured the indoor and outdoor areas of the facility during today's inspection. INDOOR ACTIVITY MEASUREMENT ARE AS FOLLOWS: Room B1 = (14.750 x 14.750):2 + 14.750 x 5.67 + 13.580 x 18.010 + (11.500 x 8.500):2 minus (encumbered) (12.500 x 2.080 + 2.500 x 1.660 + 2.917 x 2.583) = 450.746 sq. ft Room B2 = (25.750 x 19.167 + (14.500 x 14.833):2 minus (encumbered) (1.917 x 2.667 + 1.920 x 2.580 + 6.250 x 10.083) = 528.004 sq. ft *TOTAL INFANT INDOOR SPACE =* 978.750 sq. ft. divided by 35 *= 27 children* Report To Be Continued on Page #2

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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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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: PRIMROSE SCHOOL OF CUPERTINO	FACILITY NUMBER: 434417026
	VISIT DATE: 04/13/2022

NARRATIVE

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There are 2 sinks and 1 toilet available for the infants. LPAs observed appropriate changing tables that have raised sides (3 inches in height) and are within an arm's reach of a sink in each room. Medications will be stored in Director's office. Simaben states that the Infant program will not offer the potty training.

LPAs observed containers with tight-fitting lids for solid waste and diaper disposable. The facility has central heating/air conditioning and appropriate lighting in both classrooms. First aid kit is stored inaccessible to children. Cleaning solutions, disinfectants, and similar items are stored in the locked upper cabinet. Facility will not provide transportation.

There are 3 high chairs, 6 tables, 24 chairs, 24 hooks, 24 cots, and 24 cubbies. The Infant Room has a refrigerator and bottle warmer. There is adequate equipment and toys for children. Drinking water will be readily available to children indoors via sippy bottles and pitchers. LPAs observed functioning smoke/carbon monoxide detectors in each classroom. There are two staff restrooms that will be utilized by sick children if necessary. Sick children will be isolated in the Nurse Room and isolation equipment will be provided.

Facility provides breakfast, lunch, AM/PM snacks. Meals will be prepared in the facility’s kitchen. The food preparation area is clean and has hot and cold running water, sink, refrigerator, microwave, oven, ice maker, dishwasher, rice cooker, and storage spaces for food. Disposable plates and utensils will be utilized by the facility.

OUTDOOR MEASURES:
(35.250 x 34.000) + (16.083 x 8.417) = 1,333.871 sq. ft

TOTAL OUTDOOR SPACE:
1,117.129 sq. ft divided by 75 sq. ft per child = 17 children

Infant playground has space for 17 Infants. There is not enough space for the requested Infant capacity of 24. As a result, a waiver for playground space will be requested by the Applicant Representative.

Report To Be Continued on Page #3

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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: PRIMROSE SCHOOL OF CUPERTINO	FACILITY NUMBER: 434417026
	VISIT DATE: 04/13/2022

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LPAs observed the playground is surrounded by appropriate fencing and exclusively for Infant children. The outdoor activity space is equipped with age-appropriate toys and playstructure. Shade is provided by building overhangs. Drinking water will be available to children outdoors via sippy bottles. No bodies of water were observed. Simaben states that Infant children will walk through Preschool yard to go to Infant playground. Simaben states that facility will ensure Infant and Preschool children will not commingle at any time.

Simaben Shah, Applicant/Facility Representative, and Monica Thompson, Site Director, have obtained a Criminal Records Clearance and Child Abuse Index Checks. Director’s Pediatric First Aid/CPR Certifications expire 6/2/2022. Director has proof of completion of Preventative Health Practices and proof of immunity against Measles and Pertussis, Influenza on file.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. A Plan of Operation that includes IMS must be submitted to the Department. The following 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 reviewed with facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Facility Representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Report To Be Continued on Page #4

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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: PRIMROSE SCHOOL OF CUPERTINO	FACILITY NUMBER: 434417026
	VISIT DATE: 04/13/2022

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Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPAs discussed the safe sleep regulations with Applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Exit interview conducted and report was reviewed with the Applicant/Facility Representative, Simaben Shah. LPAs advised Simaben that a license for 24 Infant children will be submitted to Licensing Management for the final stage of approval upon the receipt of the following:

1) A waiver request for the shared playground space. Waiver was received during today's inspection.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Dung Mac	TELEPHONE: (408) 334-8546
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

LIC809 (FAS) - (06/04)

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