434416989-10-5-2021-07-CC-SCOS-C7HQYY-20211005123554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434416989
Report Date: 09/17/2021
Date Signed: 10/05/2021 12:36:03 PM

Document Has Been Signed on 10/05/2021 12:36 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:	EMC2 KIDS ACADEMY		FACILITY NUMBER:	434416989
ADMINISTRATOR:	BLANCA HERNANDEZ		FACILITY TYPE:	850
ADDRESS:	4953 STEVENS CREEK BOULEVARD		TELEPHONE:	4084095901
CITY:	SANTA CLARA	STATE: CA	ZIP CODE:	95051
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/17/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Blanca Hernandez		TIME COMPLETED:	03:49 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	Pp #1 Licensing Program Analyst (LPA), Stephanie Collins conducted an announced pre-inspection the Facility today. LPA met with Applicant Blanca Hernandez and explained the nature of today's visit. LPA toured the Facility both inside and outside during today's visit. LPA inspected Rooms 1, 2, & indoor play areas and restrooms. Preschool hours are: 9:00 AM to 12:00 PM Monday to Friday. Fire clearance was completed 7/7/2021. INDOOR MEASUREMENTS ARE AS FOLLOWS: Previous measurement taken 3/16/17 Room 1: 20.833 x 15.500 = 322.911 Room 2 (Toddler Rm) : 26.167 x 15.500 = 405.588 Play Area: 24.667 x 19.250 (minus 38.750) = 436.089 23.333 x 6.750 = 157.497 21.500 x 15.250 = 327.875 Play Area Total: 921.461 sq. ft. *TOTAL INDOOR SPACE: 1,649.960 sq. ft. divided by 60 = 27 preschool children.*

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

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 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: EMC2 KIDS ACADEMY	FACILITY NUMBER: 434416989
	VISIT DATE: 09/17/2021

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
26
27
28
29
30
31
32

Pp #2
There are 2 toilets (30) and 3 sinks (45) available for the preschool children and toddlers to use separately. LPA observed dispenser soap and disposable towels in the preschool bathrooms. Staff have one separate bathroom, located next to the children's bathroom, that children can use who become ill while in care. Sick children will be isolated in the director's office area and isolation equipment is provided. The Facility will utilize the 3-step method of soap/bleach/water for disinfecting purposes, the facility is observed as being in compliance with COVID-19 Postings, Guidelines and Protocols. LPA observed the required posted materials, including the Facility License area, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), and Activity Schedule. The Facility has one Indoor active waiver on file due to lack of outdoor space and will be compliant with the conditions of the waiver.

LPA observed that all rooms are clean and safe for all children and staff. Drinking water is readily available for the children via water cooler and pitchers/disposable cups. LPA observed solid waste containers with tight-fitting lids in the facility. Staff and children's restrooms are clean, sanitary, and operable. Blanca states that there are no weapons or firearms on the premises. LPA informed Blanca Baby walker are prohibited on the premises or No smoking.

LPA observed all furniture and equipment is in good condition and safe for the children. The Facility has no outdoor space and uses the Play Area as a multipurpose area for gross motor activities. Waiver for indoor play-space has been requested. The food preparation and storage areas are clean and free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children. First aid supplies were observed. Working functioning fire extinguisher and Carbon Monoxide detector observed.

Blanca states that the Facility will administer medications if needed. Incidental Medical Services (IMS) policy was discussed. Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated 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)/ (800) 514-0 LPA discussed the following posting and forms:

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

LIC809 (FAS) - (06/04)

Page: 3 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: EMC2 KIDS ACADEMY	FACILITY NUMBER: 434416989
	VISIT DATE: 09/17/2021

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
26
27
28
29
30
31
32

Pp#3
A review of staff records on September 17, 2021 indicates individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded Blanca of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12 month period.

Blanca understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities.
POSTING REQUIREMENTS: Facility License/Waivers 101160 Personal Rights (LIC 613A) 101223(b)(2) ,PUB 393, CCC Parents RightsPoster) 101218.1(c),Lunch/Snack Menu 101221(a)(6) ,Car Seat Law (PUB 269 Child Passenger Safety Law),101225(f),Emergency Disaster Plan (LIC 610) 101174(a),Earthquake Preparedness Checklist (LIC 9148) Emergency and Disaster Information: PIN19-18.1-CCP PIN 19-18.1

DOCUMENTS PROVIDED AND DISCUSSED: Safe Sleep Awareness: PIN 19-02-CCP (8 pages) Safe Sleep Awareness,Lead Flyer Requirement: PIN 20-01-CCP PIN 20-01 Forms and Records to Keep in your Child Care Center (LIC 311A) ,Incidental Medical Services (IMS) discussed

Licensing Forms, Title 22 Regulations and information can be obtained through the internet at www.cdss.ca.gov.
LPA discussed the requirements of AB 633 to Applicant Representative, Blanca Hernandez and provided her the fact sheet and she understands the requirements.

LPA conducted an exit interview with Blanca Hernandez and advised her that a license for 27 preschool children (12 PS/15 Toddlers) will be approved upon receipt of the following
1: Remaining Required Documents
2: Management's final Review and Approval

SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3