434417025-4-14-2022-07-CC-SCOS-CDGP4X-20220414105951

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417025
Report Date: 04/13/2022
Date Signed: 04/14/2022 11:08:18 AM

Document Has Been Signed on 04/14/2022 11:08 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	PRIMROSE SCHOOL OF CUPERTINO		FACILITY NUMBER:	434417025
ADMINISTRATOR:	MONICA THOMPSON		FACILITY TYPE:	850
ADDRESS:	1002 SOUTH DE ANZA BOULEVARD		TELEPHONE:	4086857133
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY:	130	CENSUS: 0	DATE:	04/13/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Sima Shah & Monica Thompson		TIME COMPLETED:	07:11 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	Page 1 Facility Pre-License Primrose School of Cupertino Licensing Program Analysts (LPA), Stephanie Collins and Mac Dung met with Owner Sima Shah and site Director : Monica Thompson for a pre-licensing inspection. Applicant PSWG LLC. is applying for a license to operate a Preschool Center at the address listed above. The quested capacity is 130 Preschool Children ages (2) two years to entry into first grade . A Fire Clearance was granted on 03/018/2020 by SJFD. LPA inspected the indoor and outdoor, on limit and off limit areas, as well as measured the space available for the children to ensure at least 35 square foot of indoor activity space and 75 squire feet on outdoor activity space is available for children per regulations. Indoor measurements are as follows: Preschool Class Room = (Total sq. ft.) – (Total Encumbered Space) = total Square footage (Early Preschool )- EPS 1 Room : (28.333 sq. ft. ) x (19.42 sq.ft ) x (1.00 sq.ft) – (11.sq. ft) = 563.6333 sq. ft. EPS 2 Room : (28.917 sq.ft ) X (19.416 sq.ft.) x (10.917 x 9.667) x (9.917 x 9.833) – 11.00 ft. = 753.528 sq.ft Preschool 1 : (31.666 sq. ft) x (22.33 sq. ft) x (1.sq ft.) x (10.92 sq.ft.) x (1.83 – (18.499 sq.ft) x ( 6.92 sq ft x (24.33 sq.ft) x (1.833 sq.ft.) x (1.sq. ft.) – (11.sq ft) = 884.323 sq.ft Preschool 2: (27.83 sq.ft ) x (27.333 sq. ft) x (9.66 sq. ft.) x ( 12.583 sq.ft - (11.Sq.ft.) =871.398 sq. ft Pre- Kindergarten 1: (38.17 sq. ft) x (20.42 sq. ft) x ( 1. sq. ft. )x (8.58 sq.ft) x (9.25 sq. ft.) =874.698 sq. ft. Pre- Kindergarten 2: (8.92 sq.ft)x( 6.666 sq. ft) x (0.5 sq.ft) x (27 sq.ft.) x (14.92 sq ft) x(1.sq. ft.) x (28.92 sq. ft) x. (12.92 .sq ft.) x (1 sq.ft.) x (15.58. sq. ft) x (3.58) x (1.sq.ft.) – (11.273 sq.ft) = 850.719

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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: PRIMROSE SCHOOL OF CUPERTINO	FACILITY NUMBER: 434417025
	VISIT DATE: 04/13/2022

NARRATIVE

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Total Preschool Indoor Activity Space = 4,798.299 divided by (35 sq. ft. / child)
= 137 Preschool children

Preschool Yard:
= (Total sq. ft.) – (Total Encumbered Space) = (2,460.288 sq. ft.) – (0)
= 2,460.288 sq. ft.

Total Preschool Outdoor Activity Space = 2,460.288 (sq. ft.) divided by (75 sq. ft.
= 32 Children
There are 12/180 sinks and 11/165 toilet designated for Preschool children to use.

There is one staff restroom in common area that will also be used by children who becomes ill. Sick children will be isolated in the Nurses Office and isolation equipment will be provided. First aid supplies in each class room where observed. Hot water temperature controls where maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by children to attain a hot water temperature between 105 degrees F and 120 degrees F- per regulation. Medications are keep locked and stored in directors office inaccessible to children. LPA's observed sufficient cots, cubbies, hanging coat/backpack hooks, toy and play materials available for children. The center will provide meals (Breakfast/Lunch) AM and PM snacks. The meals will be catered in by US Foods. Meals can be stored, refrigerated and heated as needed at the on-site fully equipped kitchen until served to the children. The kitchen has a preparation area, storage areas, is equipped with stove, convection oven, hot and cold running water, three (3) industrial refrigerators, dishwasher, ice maker, two industrial rice makers, hot and cold running water disposal dishes as well as reusable utensils and dishes that can be cleaned and sanitized daily. LPA observed trash cans with tight fitting covers for disposal of solid waste. Drinking water indoors will be available via water jug, pitchers and children's individual labeled Sippy cups. LPA's observed functioning smoke and carbon monoxide detectors, and fire extinguishers - (3A-40B:C) at the facility. The facility staff will clean and sanitize toys, and equipment daily. Cleaning solution will be kept inaccessible to children. Medication will be stored and locked in the director’s office . The center will be cleaned nightly by the Jenpro cleaning company. LPA's observed adequate toys, furniture, and equipment such as tables, chairs, cots , etc.

The Preschool playground is enclosed by fencing. Areas around and under climbing structures have material (turf) that absorbs falls. Shade is provided by canopies, and overhang. Drinking water outdoors is available via water pitcher and Sippy cups (with names on cups) . The center will not provide transportation. There is a working telephone which is (408) 516- 3900.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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: PRIMROSE SCHOOL OF CUPERTINO	FACILITY NUMBER: 434417025
	VISIT DATE: 04/13/2022

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Facility representative’s Monica Thompson and Sima Shah was reminded that all adults 18 and over, 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.

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)/ (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

LPA reviewed with Sima Shah and Monica Thompson the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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 email communication.

Exit interview was conducted, where this report was reviewed with owner Sima Shah and Site Director Monica Thompson and both were informed application is pending management's final review and approval.

Documents submitted at time of inspection:

Playground ground waiver request
Playground schedule
Letter of work experience for (Director Monica Thompson)
Proof of fire and carbon monoxide detectors by SJFD are actively engaged and functional.

SUPERVISOR'S NAME: Mary Segura	TELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Stephanie Collins	TELEPHONE: (408) 334-8555
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

LIC809 (FAS) - (06/04)

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