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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416983
Report Date: 10/12/2021
Date Signed: 10/12/2021 05:09:17 PM

Document Has Been Signed on 10/12/2021 05:09 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:GILROY HEAD STARTFACILITY NUMBER:
434416983
ADMINISTRATOR:RENEE GARCIA / EVA SUAREZFACILITY TYPE:
850
ADDRESS:9300 WREN AVENUETELEPHONE:
(669) 212-8692
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 30TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
10/12/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Eva SuarezTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Samantha Yip conducted an announced pre-licensing inspection. LPA met with Site Director Eva Suarez and explained the reason for the inspection. The purpose of the inspection is the facility requested a change of capacity from 43 children to 30 children ages 2.9 to entry to kindergarten due to the number of toilets and sinks for children. An updated fire clearance for 30 children was granted on 10/05/2021 for Room K-1, Room K-2, and the outside area.

There is board to post required postings. LPA observed COVID posters. Site Director stated that be conducting health screening outside of Room K-1.

Measurements for the facility was conducted on 07/26/2021. The measurement are as followed:
THE INDOOR MEASUREMENTS ARE AS FOLLOW:
ROOM K-1:
(12.750 x 11.417= 145.566) + (15.250 x 5.083 = 77.515) + (24 x 9.33 = 223.992) + (28 x 15.250 = 427) + (0.583 x 21.250 = 12. 388) + (27.417 x 7.583 = 207.903) + (29.333 x 7.250= 212.664) = 1307.028 minus encumbered space (13.250 x 2.083 = 27.599) + (1.583 x 15.500 = 24.536) = 52.135 = 1307.028- 52.135 = 1254.893
Total Indoor Space: 1254.893 divided by 35 = 35 children

ROOM K-2:
(7.667 x 27.333 = 209.562) + (12.750 x 11.667= 148.754) + (35.333 x 14.667 = 518.229) + (30 x 9.083 = 272.49) + (0.58 x 21= 12.243 )+ (7.417 x 3 = 22.251) = 1183.529 minus encumbered space (16.250 x 1.500 = 24.375) + (12.750 x 2.083) = 50.993 = 1183.529-50.993 = 1132.596
Total Indoor Space: 1132.596 divided by 35 = 32 children

-----------------------CONTINUES ON 809 DATED 10/12/2021 PAGE 2----------------------------
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2021
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: GILROY HEAD START
FACILITY NUMBER: 434416983
VISIT DATE: 10/12/2021
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--------------------CONTINUATION OF 809 DATED 10/12/2021 PAGE 1--------------------------
THE OUTDOOR AREAS ARE AS FOLLOWED:
77.167x49.750 = 3839.058 + 14.667 x 24 = 352.008 + 57.083 x 54.667= 3120.556 + 3.500 x 44.417 = 155.459 + 13 x 43.250 = 562.25 + 15 x 22.167= 332.505 + 1.167 x 8.667 = 10.114 1.500 x 23.333 = 34.999 + 1/2(38.417 x 38.11)= 732.035 = 9138.984 minus encumbered space 3.667 x 7.7750 = 28.419 + 3(2.250 x 2.250) = 15.187 = 43.606 = 9138.984 - 43.606 = 9095.378
Total Outdoor Space: 9095.378 divided by 75 = 121 children

There are 2 toilets, 2 sinks, 60 cubbies, 43 chairs, 11 tables, and 19 napping mats. Facility will only have one full-time classroom. All cleaning supplies, disinfectant were observed to be inaccessible. LPA reminded Site Director that any hand sanitizer needs to inaccessible to children. LPA observed that there are toys for children. Facility plans on using the office (Room 1) and the girls restroom for sick children. A waiver request was submitted for the facility to use the girls restroom for sick children. There is a fully charged fire extinguisher, smoke detector, and carbon monoxide detector. Site Director stated that there are no weapons, such as firearms, stored on the premise.

The outdoor areas is fenced. There is resilient material surrounding the play structure. LPA observed that resilient material below the ladder on the play structure was fixed and is not sinking. LPA also observed that edge of the stairs is still rusty. Site Director stated that they are still waiting to hear from the building facility to get the stair repaired. Site Director stated that she will follow-up with LPA regarding stairs. Play structure was power washed. There were no bodies of water observed during today's inspection.

Facility plans on providing meals and snacks to children. All meals and snacks are prepared and brought from Santa Clara County Office of Education. There is a kitchen to prepare meals and snacks. Sink has hot and cold running water. Drinking water inside is provided through water cooler and cups and through the water fountains and water jug and cups outside. There is tight fitted trash can for waste.

Facility does plan on providing Incidental Medical Services (IMS). Plan of Providing IMS is on file.

All staff are fingerprinted through Santa Clara County Office of Education. Therefore, all criminal records are monitored through the Santa Clara Country Office of Education.

An exit interview was conducted with Site Director Eva Suarez. Site Director was informed that upon approval of Licensing Management, a license for a preschool child care center will be granted and issued.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
LIC809 (FAS) - (06/04)
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