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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416695
Report Date: 03/08/2023
Date Signed: 03/08/2023 04:46:32 PM

Document Has Been Signed on 03/08/2023 04:46 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:LITTLE OAK NURSERYFACILITY NUMBER:
434416695
ADMINISTRATOR:JENNIFER POTMESILFACILITY TYPE:
830
ADDRESS:1921 CLARINDA WAYTELEPHONE:
(408) 396-1252
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 30TOTAL ENROLLED CHILDREN: 15CENSUS: 11DATE:
03/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jennifer Potmesit & Annie ChouTIME COMPLETED:
05:00 PM
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Licensing Program Analysts (LPAs) Marilou Monico and Farida Raja met with Site Director, Jennifer Potmesil, and Executive Director, Annie Chou, for the purpose of conducting a Case Management Inspection. The facility submitted an application to change the capacity from 30 to 16 children and removing Room 32 on the license. Fire clearance was approved on February 1, 2023.

The Infant Program operates Monday through Friday from 8:00 AM to 5:00 PM, serving children ages birth to 24 months. LPAs toured the facility during today's inspection as well measured the space available for the children.

The following are indoor measurements and information:
Room 8: 31.417 x 26.000 = 816.842
1/2 (10.083 x 7.583) = 38.229
1/2 (10.750 x 7.583) = 40.758
Room 8 total = 895.835 minus 382.417 (encumbered space) = 513.418

Room 9: 31.417 x 26.000 = 816.842
1/2 (10.083 x 7.583) = 38.229
1/2 (10.750 x 7.583) = 40.758
Room 8 total = 895.835 minus 374.653 (encumbered space) = 521.182
TOTAL INFANT INDOOR SPACE = 1,034.60 sq. ft. divided by 35 = 29 children



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SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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: LITTLE OAK NURSERY
FACILITY NUMBER: 434416695
VISIT DATE: 03/08/2023
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The Infant Program has 2 sinks (30) available for the children. The sinks used by children only have cold running water. There are two staff bathrooms at the facility located next to Room 20 in the Office Building. There is a separate bathroom for sick children located in Room 11. Sick children will be isolated in Room 11 and isolation equipment will be provided. Staff and children's bathrooms are clean, sanitary, and operable.

LPAs observed containers with tight-fitting lids for the disposal of solid waste and diapers. First aid supplies are stored in each classroom inaccessible to children. Cleaning supplies are stored in the upper cabinet in each room out of reach of children. LPAs observed smoke and carbon monoxide detectors and appropriate lighting in each classroom. The facility has heating and air conditioning. Medications are in a lock box stored in each room inaccessible to children. LPAs observed diaper changing tables within arm's reach of a sink.

Jennifer understands that the facility must be kept free of flies, other insects & rodents. LPAs observed that all furniture and equipment indoors are in good condition and safe for the children. Drinking water is readily available for the children indoors bottles and sippy cups. Parents provide lunch and snacks for their children.

There are 2 tables, 4 chairs, 36 hooks, 9 cots, 18 cribs, and 15 high chairs for the children. There is adequate equipment, supplies, and toys for the children in each classroom.

This facility provides Incidental Medical Services – IMS. LPAs reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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.

The following are outdoor measurements and information:

Portion of Playground 3: 59.833 x 88.083 = 5,270.270 (grass & tanbark areas) TOTAL INFANT OUTDOOR SPACE: 5,270.270 sq. ft. divided by 75 sq. ft. = 70 children


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

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LITTLE OAK NURSERY
FACILITY NUMBER: 434416695
VISIT DATE: 03/08/2023
NARRATIVE
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LPAs observed the playground is surrounded by appropriate fencing and the outdoor surfaces are safe. Shades are provided by trees. Drinking water outdoor is provided bottles and sippy cups. No bodies of water were observed.

Site Director 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Exit interview conducted and report was reviewed with Jennifer Potmesil, Site Director . LPAs advised Jennifer that a license for 16 children in the Infant Program is approved effective today, Mach 8, 2023.

There were no deficiencies cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

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

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC809 (FAS) - (06/04)
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