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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416369
Report Date: 02/15/2023
Date Signed: 02/15/2023 10:33:13 AM

Document Has Been Signed on 02/15/2023 10:33 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:KIDSPARKFACILITY NUMBER:
434416369
ADMINISTRATOR:DEBBIE MILNERFACILITY TYPE:
840
ADDRESS:820 S WINCHESTER BLVD #120TELEPHONE:
(408) 206-3404
CITY:SAN JOSESTATE: CAZIP CODE:
95128
CAPACITY: 50TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/15/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Lisa Alvarado & Melissa PetersTIME COMPLETED:
10:40 AM
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Regional Manager (RM), Anthony Studebaker, and Licensing Program Analyst (LPA), Marilou Monico, met with Site Director, Lisa Alvarado, and Franchise Support Manager, Melissa Peters, for the purpose of conducting a Prelicensing Inspection. An initial Prelicensing Inspection was conducted on November 18, 2022.

RM and LPA toured the indoor areas of the facility during today's inspection. The following measurements were taken by LPA Monico on November 18, 2022:

Indoor Activity Space:
MOUNTAIN OF ENERGY = 19.583 x 26.500 = 518.949
THEATER/PLAY HOUSE/CREATION STATION: 49.500 x 53.667 = 2,656.516 minus 588.25 (encumbered space) = 2,068.266
BLUE CREW = 22.667 x 17.583 = 398.553
TOTAL INDOOR SPACE = 2,985.768 sq. ft. divided by 60 sq. ft. = 50 children

The school age program has 3 sinks (45), 3 toilets (45) available for the children. The sinks only have cold running water. There is a staff bathroom with one (1) toilet and one (1) sink located in the next building, 812 S. Winchester Blvd., Suite 150, San Jose, CA 95128. The sick children will be using the staff bathroom if needed and will be escorted by a staff member. Sick children will be isolated in the Office located at 812 S. Winchester Blvd. Suite 150, San Jose, CA 95128 and isolation equipment will be provided. Staff and children's bathrooms are clean, sanitary, and operable. Cleaning products are stored in a locked closet near the school age bathrooms.

Continuation on next page:

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 2
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: KIDSPARK
FACILITY NUMBER: 434416369
VISIT DATE: 02/15/2023
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Fire clearance for 50 school age children was granted on November 2, 2022.

Since the school age program only has 3 sinks (45) and 3 toilets (45), a license for 45 children will be approved effective February 16, 2023.

Waivers on file for flexible capacity, outdoor activity space, commingling of age groups, fixtures, equipment and supplies.

Exit interview conducted and report was reviewed with Site Director, Lisa Alvarado, and Franchise Support Manager, Melissa Peters.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2023
LIC809 (FAS) - (06/04)
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