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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440709682
Report Date: 08/15/2019
Date Signed: 08/15/2019 10:45:34 AM

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:GOOD SHEPHERD SCHOOLFACILITY NUMBER:
440709682
ADMINISTRATOR:KRISTEN BARKMANFACILITY TYPE:
850
ADDRESS:2727 MATTISON LANETELEPHONE:
(831) 476-4000
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY:30CENSUS: 0DATE:
08/15/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Kristen BarkmanTIME COMPLETED:
11:00 AM
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LPA Mahvash Behbood met with Applicant representative, Kristen Barkman. Currently this facility is licensed for 30 children in 2 classrooms. The classrooms are located on Good Shepherd Elementary School premises. The classrooms are identified as Pre-K and Pre-school. Facility is requesting to move the pre-school class to a new classroom faciltiy will keep the Pre-K classroom as is. For now the capacity will remain the same.
Analyst measured the both classrooms.
Measurements are as follows:
TOTAL SPACE MEASURED:

Pre-School(PS) Room (33.250 X 12.500 = 415.625 ) + (18.750 X 27.312 = 520.312) = 935.937 SQ.FT
935.937 divided by 35 = 26 children.

Pre-K Classroom (10.083 X 32 = 326.860 ) + (27 X 17 = 459 ) + (7 X 5.250 = 36.75) = 822.61 minus encumbered space (6.500 X 8.583 + 55.789) = 766.821 SQ.FT
766.821 divided by 35 = 21 children

In each classroom there are 2 toilets and one sink so the maximum capacity for each room is 15 based on the number of sink available. There are total of 7 tables and 36 chairs for both classrooms.
Facility is sharing the playground with the kindergartners from the Elementary School.
Fire clearance for the new classroom has been granted.
The change of classroom for the capacity of 15 per classroom is approved pending
adding tan barks to play ground and pulling all the weeds out.
The picture of playground must be forwarded to analyst no later than 08/20/19.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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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