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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416691
Report Date: 12/15/2023
Date Signed: 12/15/2023 10:25:37 AM

Document Has Been Signed on 12/15/2023 10:25 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LITTLE VILLAGE PRESCHOOL, THEFACILITY NUMBER:
434416691
ADMINISTRATOR:CHANEL ROLANDFACILITY TYPE:
850
ADDRESS:14381 BERCAW LANETELEPHONE:
(408) 412-8655
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 23DATE:
12/15/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Chanel RolandTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Harsimran Kaur conducted an announced inspection of the facility today and met with Director, Chanel Roland. The inspection is in response to facility’s request for an decrease capacity to 60 preschool children. Fire inspection was conducted on 12/05/23 and clearance granted and approved for center.

LPA toured the indoor and outdoor areas of the facility during today's inspection and was observed to be in good order. The facility designated room 3 and garden play-yard for infant and toddler component #434417132. Preschool program will run in room 1,2.4 and play-yard. Director submitted waiver for outdoor space to LPA.

There are 6 sinks and 5 toilets designated for Preschool children to use.

The facility has adequate number of toilets, sinks and supplies for the requested capacity.

The Indoor total measurements contain a total of {2080.66} square feet, which will accommodate Applicant’s request for 60 preschoolers.

Outdoor total measurements contain a total of {3659.58} square feet, which will not accommodate Applicant’s request for 60 preschoolers.

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2023
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LITTLE VILLAGE PRESCHOOL, THE
FACILITY NUMBER: 434416691
VISIT DATE: 12/15/2023
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LPA/LPM discussed the safe sleep regulations with Site Director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA/LPM informed Site Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive communication.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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


Exit interview conducted and report was reviewed with Chanel Roland, Director. Copy of the report was provided. Final license determination will be made upon review by Licensing Program Manager.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023
LIC809 (FAS) - (06/04)
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