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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416989
Report Date: 08/04/2025
Date Signed: 08/04/2025 03:26:48 PM

Document Has Been Signed on 08/04/2025 03:26 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:EMC2 KIDS ACADEMYFACILITY NUMBER:
434416989
ADMINISTRATOR/
DIRECTOR:		BLANCA HERNANDEZFACILITY TYPE:
850
ADDRESS:4953 STEVENS CREEK BOULEVARDTELEPHONE:
(408) 409-5901
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY: 27TOTAL ENROLLED CHILDREN: 22CENSUS: 14DATE:
08/04/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Blanca HernandezTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analysts(LPAs)Anna Morales and Liridon "Doni" Fici conducted an Unannounced Case Management Inspection and was greeted by Director Blanca Hernandez, two staff and 14 children. Hours of Operation are 9am-6pm, and is a part-time program. Director requested a Fire Clearance for an outdoor play ground that has been placed in the back of the facility's parking lot. The Fire Clearance was granted on 7/25/25 for 27 children. Director has submitted the Permit from the City of Santa Clara that was granted on 6/25/25 for the Outdoor Fenced Playground. Facility was licensed with a indoor playground(Room 3).

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

Room 3/Activity Room: 24.667 x 19.250 (minus 38.750) = 436.089
23.333 x 6.750 = 157.497
21.500 x 15.250 = 327.875
Total: 921.461 sq. ft.
322.911+405.588+921.461=1,649.95 divided by 35 sq.ft=47 children

During today's inspection, LPAs Anna Morales and Doni Fici measured the outdoor play yard:
12.08(L)x 23.25(W)= 280.86
41(L) x 26.08(W)=1,069.28
TOTAL: =1,350.14 sq ft divided 75 sq ft=18 children
NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Anna Morales
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: EMC2 KIDS ACADEMY
FACILITY NUMBER: 434416989
VISIT DATE: 08/04/2025
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LPA's observed three sinks, two toilets, one toilet for staff/children who are ill, and for emergency use. LPAs observed 5 tables, 39 chairs, 20 cubbies and 8 cots. Director stated that she has extra cots available, if needed. Children bring their own lunches and snacks. Facility has a filter water dispenser for the children, and children bring their own water bottles. Facility has a refrigerator available. Director stated that there are no weapons on the premises.

LPAs observed the fencing surrounding the outdoor playground is at least four feet high. Shade is provided by canopies. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is adequate cushioning in the play ground. LPAs did not observe any climbing structures and no bodies of water.

Based on today's inspection, LPAs determined that the facility's physical plant is in compliance with applicable Health & Safety Codes and Title 22 Regulations.

Currently the Facility offers a Part time program(9am-12pm/1pm-6pm) Director stated that once the Outdoor playground has been approved, she will submit an updated Program Plan and Parent Handbook/Admission to reflect a full time program hours.

LPA conducted an exit interview and advised Director Blanca Hernandez that request for a capacity of 27 Preschool Program will be approved upon review by submitting the following:

1. Waiver for Outdoor Playground as the Facility is licensed for 27 children and the Outdoor playground measured for 18 children. The waiver is to include a play time schedule for each of the classrooms.

No deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days. Appeal Rights Given.


NAME OF LICENSING PROGRAM MANAGER: Gladys Kuizon
NAME OF LICENSING PROGRAM ANALYST: Anna Morales
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC809 (FAS) - (06/04)
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