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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710145
Report Date: 09/06/2024
Date Signed: 09/06/2024 05:16:15 PM

Document Has Been Signed on 09/06/2024 05:16 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:PRIMARY PLUSFACILITY NUMBER:
430710145
ADMINISTRATOR/
DIRECTOR:		GUZMAN, SHUREEFACILITY TYPE:
840
ADDRESS:18720 BUCKNALL RDTELEPHONE:
(408) 370-0357
CITY:SARATOGASTATE: CAZIP CODE:
95070
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 8DATE:
09/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Shuree GuzmanTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Jennifer "Jen" Beehler and Samantha Yip met with Site Director, Shuree Guzman for a Case Management- Licensee Initiated inspection. The purpose of today's visit was to change the rooms for the school age program to rooms 6A and 10. Facility capacity will need to change to accommodate the classroom reduction. The program will service school age children (4.9 years old - 12 years old). The child care center will operate Monday–Friday 6:30AM – 6:00PM. The fire clearance was approved on 08/26/24. The outdoor area dedicated for the school age children is the school age backyard area. The facility stated that they will submit a waiver request for this space to be used by the preschool program at different times. Director understands the preschool and school age children cannot share the outdoor space until a waiver has been granted.

LPAs toured and measured the indoor and outdoor areas of the Facility during today's inspection.



6A Classroom measurements are:
The Indoor total measurements contain a total of {625.11} square feet.

10 Classroom measurements are:
The Indoor total measurements contain a total of {837.69} square feet.

Interior classroom measurements total of 1,462.80 square feet, which will allow a capacity of 41 school age children.

CONTINUED on 809-C.....
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2024
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: PRIMARY PLUS
FACILITY NUMBER: 430710145
VISIT DATE: 09/06/2024
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CONTINUED FROM 809.......
School-Age Outdoor Play measurements are:
Outdoor total measurements contain a total of 4,453.68 square feet, this will support the capacity change of 41 school age children.

All indoor and outdoor activity space utilized for the children were inspected today. LPAs informed licensee that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. 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 40 chairs, 5 tables, 24 lockers, 23 hooks, 8 toilets and 8 sinks along with 3 urinals. Director understands that restrooms cannot be shared with the preschool program. There is a separate staff bathroom that is not utilized by the children which an isolated child can use if needed. There is a fully equipped first aid kit located in each classroom. There is an operational carbon monoxide detector on site.

LPAs observed that the teacher/child ratio was in compliance during today's visit. The licensee shall take measures to keep the center free of flies, other insects, and rodents. All containers used for storage of solid wastes, including moveable bins, shall have a tight fitting cover that is kept on. LPAs observed no fireplace or open face heaters. The facility provides an AM/PM snack that is pre-packaged. Lunch is provided by parents or a hot lunch can be purchased, which is delivered to the site daily. LPAs advised Director as per Title 22, if food is prepared off the center premises, the following shall apply: (A)The preparation source shall meet all applicable requirements for commercial food services. (B)The center shall have the equipment and staff necessary to receive and serve the food and to clean up. (C)The center shall maintain the equipment necessary
CONTINUED on 809-C......
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
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: PRIMARY PLUS
FACILITY NUMBER: 430710145
VISIT DATE: 09/06/2024
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Continued from 809-C........
for in-house food preparation, or shall have an alternate source for food preparation and service in the event of an emergency. Commercial foods shall be approved by appropriate federal, state and local authorities. All foods shall be selected, transported, stored, prepared and served so as to be free from contamination and spoilage and shall be fit for human consumption. LPAs observed the classrooms had mini refrigerators and microwaves.

LPAs observed cobwebs in the corner under the cabinets where the kids have hooks to hang their personal affects in room 10.

LPAs observed the facility has a fully fenced outdoor playground. There is adequate age appropriate supplies and toys outdoors. Shade rest area is provided by trees and building overhang. Drinking water is provided through water coolers and cups. 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 informed Director that the request for classroom changes shall be approved with the following conditions:

1 LIC 200A to reflect the change of capacity
2. Change of capacity fee of $25
3. Updated fire clearance
4. Final review and approval of application packet by Licensing Program Manager.

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

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Jennifer Beehler
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024
LIC809 (FAS) - (06/04)
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