<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434406724
Report Date: 10/13/2023
Date Signed: 10/13/2023 01:00:15 PM

Document Has Been Signed on 10/13/2023 01:00 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:CAPRI PRESCHOOLFACILITY NUMBER:
434406724
ADMINISTRATOR:HEATHER ELSTONFACILITY TYPE:
850
ADDRESS:850 CHAPMAN DRIVETELEPHONE:
(408) 341-7127
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 19DATE:
10/13/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Angela De La CruzTIME COMPLETED:
01:10 PM
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 Analysts (LPAs), Ashley Lopez and Cortney Nelson, conducted a Case Management visit to follow up on a previous inspection to remeasure the square footage of classroom. LPAs met with Director, Angela De La Cruz. This visit was conducted in response to the Licensee’s request to remove room K2 from the Preschool license and decrease the capacity from 58 to 24 children, ages 2 to 6 years old. The preschool's days and hours of operation are Monday – Friday from 8:15am to 12:15pm. Facility's License, Notification of Parents’ Right Poster, Child Car Seat Law, Personal Rights (LIC 613A), Emergency Disaster Plan, Menus, Activity Schedule, and Earthquake Preparedness Checklist were observed to be posted. The fire clearance was granted on 8/28/23.

Indoor Measurements are as follows:
246.251 + 607.818 + 81.543 + 244 + 13 = 1,224.612
Encumbered: 1.73 + 30.512 + 10.702 + 10.125 + 120.743 + 32.166 = 205.978

Total: 1224.612 - 205.978 = 1018.634 divided by 35 = 29 children

Outdoor Measurements are as follows:
2079.286 + 3357.663 + 81.362 + 948.253 + 80.842 + 453.263 = 7000.669
Encumbered: 10.167 x 12.167 = 123.701

Total: 7000.669 - 123.701 = 91 children

The outdoor area has shade provided by a canopy and the building overhang. There were no bodies of water observed during today's inspection. Areas around play structure has sufficient resilient material.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 10/13/2023 01:00 PM - It Cannot Be Edited


Created By: Ashley Lopez On 10/13/2023 at 11:41 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: CAPRI PRESCHOOL
FACILITY NUMBER: 434406724

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
101212(b)

1
2
3
4
5
6
7
101212(b) Reporting Requirements: The name of the child care center director...shall be reported to the Department within 10 days of a change of child care center director or designee.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The director states she will submit her required documents to update the director on the facility's file. Exception request to be submitted for 3 units of admin/staff relations.
8
9
10
11
12
13
14
The licensee did not notify the Department of change of the Director, which poses a potential risk to the health, safety, and personal rights of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Joel Segura
LICENSING EVALUATOR NAME:Ashley Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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: CAPRI PRESCHOOL
FACILITY NUMBER: 434406724
VISIT DATE: 10/13/2023
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
26
27
28
29
30
31
32
Angela states she is the new director at the facility since the beginning of this school year, LPAs advised her of the steps to take to update her as the director. The classroom has 2 toilets and 2 sinks. LPAs advised the director to submit a waiver request for the sick child isolation bathroom. Per Section 101239 (i). there shall be one toilet and one hand washing fixture, separate from and in addition to, the number of toilets and hand washing fixtures required for requested capacity.

A deficiency will be cited during today’s visit, see LIC809-D.

Exit interview was conducted with Director, Angela De La Cruz, and advised that a request to remove Room K2 and decrease the capacity to 24 children on the Preschool license is pending for management final review and approval and the following corrections:

-Waiver request to be submitted for isolation restroom
-Site Director qualifications/ Exception Request to be submitted for review

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE OF THE FACILITY AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3