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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440710237
Report Date: 08/03/2022
Date Signed: 08/10/2022 12:23:46 PM


Document Has Been Signed on 08/10/2022 12:23 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131



FACILITY NAME:DE LA VEAGA CKC INC.FACILITY NUMBER:
440710237
ADMINISTRATOR:PAYA VANGFACILITY TYPE:
840
ADDRESS:1145 MORRISSEY BOULEVARDTELEPHONE:
8314267402
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY:100CENSUS: 0DATE:
08/03/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Noel ShermanTIME COMPLETED:
03:07 PM
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Licensing Program Analyst (LPA) Stephanie Collins conducted an unannounced Pre-Licensing inspection of the facility. LPA met with the Applicant's Representatives Executive Director Noel Schermann, The Applicant Campus Kids Connection, INC. is applying an increase in capacity to their license to operate a school-age program center from 100 to 200 School Age Children at the address listed above. Adding room #30 (The full capacity of Multipurpose Room) with a capacity of 50 students (Per Santa Cruz City Schools Assistant Superintendent Authorization Letter) bringing the total maximum capacity of the School Age Center program to 200 School Age Children in rooms #34 #35 and room #33 (Multipurpose Room) .

The school-age center is located on a functioning school site: De Laveage Elementary School located at 1145 Morrissey Boulevard Santa Cruz CA. 95065. Fire extinguisher (2A-10-BC) was observed in the classrooms with functioning carbon monoxide detectors . Facility maintains telephone service.(831) 426-7402

Since this school-age program will be operating on a functioning school site, the Program is exempt from square-footage requirements for indoor and outdoor activity space, and toilet requirements for child day care centers, pursuant to Health and Safety Code Section 1596.806.

Children have access to the restrooms, sinks, and water fountains on the school site. LPA observed that there are separate staff toilets and sinks available. There are water fountains inside the classrooms and outside, children will have accesses to water pitchers and are encouraged to bring their own water bottles .

The children will be using the Elementary School's field and playground for outdoor activities. The outdoor activity space is enclosed with fencing. Areas under high climbing equipment has material that absorbs falls. Adequate furniture and equipment for children to use were observed. There were tables and chairs to accommodate the maximum capacity of children requested. Weapons will not be stored on the premises. The program will not be providing transportation.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2022
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: DE LA VEAGA CKC INC.
FACILITY NUMBER: 440710237
VISIT DATE: 08/03/2022
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Facility representative Executive Director Noel Schermann 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.



LPA reviewed with Executive Director Noel Schermann, the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.



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.

This Facility Evaluation Report will be forwarded to management for final review and approval for the capacity increase (from 100 to 200 School Age Children) .
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Stephanie CollinsTELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2022
LIC809 (FAS) - (06/04)
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