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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430701981
Report Date: 08/20/2024
Date Signed: 08/20/2024 10:49:05 AM

Document Has Been Signed on 08/20/2024 10:49 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:WOODHAVEN PRESCHOOL AT WILLOW GLEN UMCFACILITY NUMBER:
430701981
ADMINISTRATOR/
DIRECTOR:		SMITH, SUSANFACILITY TYPE:
850
ADDRESS:1420 NEWPORT AVENUETELEPHONE:
(408) 294-6072
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 44DATE:
08/20/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Susan SmithTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Harsimran Kaur and Jennifer "Jen" Beehler conducted an unannounced case management inspection in response to a request for change of capacity from 48 to 56 preschool children. LPAs met with Susan Smith, Director, and explained to her purpose of today’s inspection. The Preschool Program currently serves children ages 2 to 5 years, in music room, preschool art room, block room, pre k 2, pre k1 and adding room 109. The Facility received a fire safety inspection approval from the San Jose Fire Department for the change of capacity on 6/14/2024. LPAs toured and measured the indoor and outdoor areas of the Facility during today's inspection.

Preschool Classroom measurements are:
The Indoor total measurements contain a total of {2409.98} square feet, which will accommodate Applicant's request for 56 preschool children.

Preschool Outdoor Play measurements are:
Outdoor total measurements contain a total of {5342.20} square feet, which will accommodate Applicant’s request for 56 preschool children.

LPAs observed classrooms are clean, safe, sanitary and in good repair. All outdoor and indoor passage ways and other areas of potential hazard were free of obstruction. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. All play equipment and materials used by children were observed to be age-appropriate. There are 55 chairs, 8 tables, 50 cubbies, 6 toilets, and 6 sinks available for preschool children. There is a separate staff toilet upstairs not utilized by the children which an isolated child can use if needed.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: WOODHAVEN PRESCHOOL AT WILLOW GLEN UMC
FACILITY NUMBER: 430701981
VISIT DATE: 08/20/2024
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LPAs observed that the teacher/child ratio was in compliance during today's visit. The
facility serves AM snacks to the preschool children.

LPAs observed that the preschool playgrounds are surrounded by appropriate fencing. The preschool playgrounds have climbing structures with sufficient resilient materials (woodchips). There is adequate age appropriate supplies and toys outdoors. Shade is provided by trees and a canopies. Drinking water is provided by water dispensers and water bottles outdoors. LPAs observed no bodies of water. Based on today's inspection, LPAs determined that the facility's physical plant is in compliance with applicable Health & Safety Codes and Title 22 Regulations.

LPAs conducted an exit interview and advised Director that request for increase in capacity for preschool children will be approved upon approval of the Licensing Program Manager.

An exit interview was conducted and a copy of appeal rights and this report was provided to Susan Smith Director. No deficiencies issued during today's inspection

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC809 (FAS) - (06/04)
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