435700706-8-11-2021-52-CC-MOTI-C5SPR7-20210811113218

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435700706
Report Date: 08/11/2021
Date Signed: 08/11/2021 11:32:24 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	CUSD MONTCLAIRE CUPERDOODLE PRESCHOOL		FACILITY NUMBER:	435700706
ADMINISTRATOR:	ALICE CHAN		FACILITY TYPE:	850
ADDRESS:	1160 ST. JOSEPH AVENUE		TELEPHONE:	(408) 252-3000
CITY:	LOS ALTOS	STATE: CA	ZIP CODE:	94024
CAPACITY:	24	CENSUS: 0	DATE:	08/11/2021
TYPE OF VISIT:	Required - 1 Year	ANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Michelle Herriage		TIME COMPLETED:	11:45 AM

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) Melanie Otsuji conducted the announced Required 1 year and Capacity Increase Inspection on today's date. LPA was met by Director of Educational Services, Michelle Herriage. Facility is currently on summer break and school returns on August 16, 2021. The center has submitted an application for a CAPACITY INCREASE. Facility is currently requesting to increase from 24 preschoolers to 48 preschoolers. A health and safety inspection was conducted inside and outside. Facility days and hours of operation are Monday through Friday 7:30AM - 6:00PM. The facility measurement was completed on a previous visit and measurements are follows: INDOORS: 1827.03 SQUARE FEET = 52 CHILDREN OUTDOORS: 10685.25 SQUARE FEET = 142 CHILDREN The center has obtained an approved fire clearance from Santa Clara County Fire Department for 48 children. CUSD Montclaire Cuperdoodle Preschool will have two approved classrooms (Room #23 and Room #24). Facility will also have 3 play yards available for preschooler. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 4 toilets, and 4 sinks available for children use. The staff have a separate bathroom in which will also serve as an isolation bathroom. Individual Medical Services (IMS) policy was discussed. When any IMS is provided, an updated 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.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CUSD MONTCLAIRE CUPERDOODLE PRESCHOOL	FACILITY NUMBER: 435700706
	VISIT DATE: 08/11/2021

NARRATIVE

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All licensing required documents are posted. Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted. The center was found to be clean, safe, sanitary and in good repair. There were no deficiencies cited during this visit.

A license for 48 preschool aged children operating out of Rooms 23 & 24 will be issued today, effective 8/11/2021.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

LIC809 (FAS) - (06/04)

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