434416313-6-14-2021-07-CC-DMAC-C3YKWD-20210614081542

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416313
Report Date: 06/03/2021
Date Signed: 06/14/2021 08:15:49 AM

Document Has Been Signed on 06/14/2021 08:15 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	FAITH HOPE & LOVE PRESCHOOL		FACILITY NUMBER:	434416313
ADMINISTRATOR:	LI-RONG TSENG		FACILITY TYPE:	850
ADDRESS:	6350 RAINBOW DRIVE		TELEPHONE:	(408) 255-1859
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY: 20	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	06/03/2021
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Sylvia Nguyen, Site Director		TIME COMPLETED:	02:50 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 Analyst (LPA) Dung Mac conducted a scheduled Tele-Pre-Licensing inspection via video conference call (FaceTime) with Sylvia Nguyen, Site Director. The Applicant is applying for a License to serve 20 children ages 3-5 years old. The Facility is located on the premises of the Church. The Center will operate Monday through Friday from 08:30AM to 05:30M. LPA notes that Faith Hope and Love Chinese School (Heritage program) is on the same premise. Preschool program will utilize Room 4 (combined Rooms 4 & 5) and Heritage program will utilize Rooms 1, 2 & 3. Sylvia understands that both the Heritage and preschool programs are separate programs and that the children cannot be commingled when both programs are in operation. The facility was inspected inside and outside via video conference call (FaceTime). During today’s video conference call, the indoor/outdoor measurements were taken by Site Director, Sylvia Nguyen, and facility staff as LPA observed the measuring process and provided direction over the video conference call. Indoor Activity Space: Room 4: (23.250 x 35.417) - (2.500 x 1.500 + 6.250 x 2.333 + 2.125 x 1.625) (encumbered) = 801.670 *TOTAL INDOOR ACTIVITY SPACE:* 801.670 sq. ft. divided by 35 sq. ft / child = 22 Preschool children**

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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: FAITH HOPE & LOVE PRESCHOOL	FACILITY NUMBER: 434416313
	VISIT DATE: 06/03/2021

NARRATIVE

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Facility has 3 sinks (45) and 2 toilets (30) for children to use. The sinks used by children only have cold running water. Facility will serve only AM and PM snacks. Children will bring their own lunch. Children who become ill will be isolated in the office with isolation equipment.

LPA observed a trash can with tight-fitting lid and smoke detector in classroom. Cleaning supplies will be stored in a locked storage outside the classroom. LPA observed that First aid supplies are stored in a locked cabinet. LPA observed refrigerator and microwave in classroom. Medications will be stored in the office.

There are 4 tables, 20 chairs, 24 cubbies, and 20 cots for the children. Drinking water is readily available for the children in the facility and outdoor playground area via filter water fountain.

Li-Rong Tseng, Applicant Representative, and Sylvia Nguyen, Director, have obtained a Criminal Records Clearance and Child Abuse Index Checks. Director has met the education and experience qualification requirements and her Pediatric First Aid/CPR Certifications expire 8/2021. Director has proof of completion of Preventative Health Practices and proof of immunity against Measles and Pertussis, Influenza on file.

OUTDOOR MEASUREMENTS:

(45.000 x 84.000) - (10.000 x 12.000) (encumbered) = 3,660.000

TOTAL OUTDOOR SPACE = 3,660sq ft divided by 75 = 48 children

Sylvia stated that the playground is exclusively for Preschool program and is surrounded by appropriate fencing. LPA observed a locked storage. No bodies of water were observed. Shade is provided by trees. The areas around and under the play structures are cushioned with material that absorbs falls.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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: FAITH HOPE & LOVE PRESCHOOL	FACILITY NUMBER: 434416313
	VISIT DATE: 06/03/2021

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LPA reminded Applicant of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the facility, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person up to $3000.00 per person.

LPA advised Sylvia that due to the current Covid-19 pandemic and "Shelter In Place" Order, the Evaluation Report will be emailed to her (email: smtsilkbaby@gmail.com) with "Read Receipt" notification. Sylvia understands that her reply to the email will serve as acknowledgement that the report was received.

LPA conducted an exit Interview and advised Sylvia that a license for 20 Preschool children will be submitted for the final stage of review by Licensing Management upon receiving of the following documents:
1) Waiver to share Girl's bathroom with Heritage program.
2) Waiver to allow ill children to share the bathroom.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

LIC809 (FAS) - (06/04)

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