434416239-11-8-2023-07-CC-MSMS-CXDVQM-20231108153833

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416239
Report Date: 11/08/2023
Date Signed: 11/08/2023 03:38:39 PM

Document Has Been Signed on 11/08/2023 03:38 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	SAFARI KID - EVERGREEN FOWLER		FACILITY NUMBER:	434416239
ADMINISTRATOR:	PALLAVI SATPATHY		FACILITY TYPE:	850
ADDRESS:	3122 FOWLER ROAD		TELEPHONE:	(408) 600-6031
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	60	CENSUS: 38	DATE:	11/08/2023
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Pallavi Satpathy & Jaishree Chitkara		TIME COMPLETED:	03:45 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), Mel Matos & Sheena Chin, met with Pallavi Satpathy, director, and Jaishree Chitkara, Licensee representative, for an unannounced Required - 3 year inspection. LPAs toured the indoor and outdoor areas of the Facility with Jaishree Chitkara, Licensee representative, during today's inspection. The Facility is licensed for 48 preschool children ages 2-6 years in the Redwood Room, Sequoia Room, & Valley Oak Room and 12 toddler option children in the Sequoia Room 1. Hours of operation: 8:00 AM to 5:30 PM Monday to Friday. The hours of operation: Monday to Friday 8 AM to 5:30 PM. There is a waiver on file for shared playground use between the preschool and toddler children. LPAs observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule. LPAs reviewed five children and five staff (1 director, 3 teachers, and one aide) files during today's inspection. Each child's file reviewed contains the Information and Emergency Information form (LIC 700). All staff files reviewed contain the required transcripts/verification of experience/immunization records, and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. There is at least one staff in the Facility with current CPR and First Aid certifications on file. Pallavi understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). Last fire/disaster drill was completed on August 14, 2023. LPAs observed that the teacher/child ratio was in compliance during today's inspection. LPAs observed four toddler children with one teacher in Sequoia Room 1, 12 preschool children with one teacher and one aide in Sequoia Room 2, and 22 preschool children with two teachers in Redwood Room. There were no preschool children in Valley Oak Room during today's inspection. Pallavi understands the conditions, limitations, and capacity specifications of the Facility license. Pallavi understands that children shall be visually supervised at all times within the classroom and in the playground areas. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the director's office area of the Facility.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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: SAFARI KID - EVERGREEN FOWLER	FACILITY NUMBER: 434416239
	VISIT DATE: 11/08/2023

NARRATIVE

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LPAs observed that the Facility is clean, safe, sanitary, and in good repair for children, staff, and visitors. The Facility has central heating and air conditioning in all rooms. Pallavi states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Drinking water is readily available for the children in each Room and in the outdoor playground area via reusable water bottles and tap water.

Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom in the Facility not utilized by the children which an isolated child can use if needed. Pallavi states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors in the Facility. Cleaning supplies are inaccessible to the children and stored in high cabinets inside each Room. LPAs observed solid waste containers with tight-fitting lids in each Room. Pallavi states that the Facility does not administer any medication at this time. Pallavi understands that smoking is not allowed on the premises.

The Facility uses reusable plates & utensils to serve AM & PM snacks and lunch. There is a kitchen area in the Facility with hot/cold water sink, toaster oven, microwave, and stove for food preparation. The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F or less.

LPAs observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by preschool & toddler children is surrounded by appropriate fencing. The outdoor surfaces are safe for the children. Shade is provided by trees and building overhangs in the playground area. LPAs observed that the outdoor equipment is age appropriate and in good condition. There is a climbing structure in the playground that is age appropriate. Rubber surfacing is used as resilient material throughout the playground. LPAs did not observe any bodies of water. There is a waiver on file for shared playground use between the toddler and preschool children. Pallavi states that she understands the terms and conditions of the waiver.

Pallavi Satpathy, director, was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.
To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
Exit interview conducted and report was reviewed with Pallavi Satpathy, director, and advised her that no deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC809 (FAS) - (06/04)

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