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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417025
Report Date: 04/19/2022
Date Signed: 04/19/2022 03:08:22 PM

Document Has Been Signed on 04/19/2022 03:08 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:PRIMROSE SCHOOL OF CUPERTINOFACILITY NUMBER:
434417025
ADMINISTRATOR:MONICA THOMPSONFACILITY TYPE:
850
ADDRESS:1002 SOUTH DE ANZA BOULEVARDTELEPHONE:
(408) 685-7133
CITY:SAN JOSESTATE: CAZIP CODE:
95129
CAPACITY: 130TOTAL ENROLLED CHILDREN: 130CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Sima Shah and Monica Thompson TIME COMPLETED:
03:30 PM
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On 4/19/2022 LPA's Stephanie Collins and Susy Cervantes met with Sima Shah and Monica Thompson. The purpose of the 2nd pre-licensing inspection continuation is to amend and clarify outdoor measurements taken during the inspection on 4/13/2021.
The following outdoor measurements were taken. 4/19/2022
Playground #1
(49.7. X 35.8) = 1779.26
35.8 12. X = 429.
6 x 9.5 X 22.8 = 216.6
4.8 x 12.1 = 29.04
Total 2,454.5 divided by 75 equal 32
Playground # 2
8.5 X 16.2 X = 137.7
33.1 X 19 =628.9
7 X 9 = 63
8.6 X 11.5 - 101.48
6 x 12.8= 38.4
(8.11 X 21) - (9.01 encumbered space )= 85.16
Total 1,045.57 divided by 75 equals 13.94 ( rounded up to 14 )
Playground # 3 (Infant playground)
18.8 X 3.7 = 69.56
8.1 X 4.6 = 37.26
19.5 X 32.7 =637.65
17.1 X 15.4 = 263.34
7 X 6.6 +23.1
7 X 11.11 = 38.89
10.3 X 20.9 =107.64
10.5 X 16.4 = 86.1 - (1.07 )
Total 1,254.47 divided by 75 equals 16
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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 2
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: 04/19/2022
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Preschool program will be using the infant playground, a schedule has been created for the shared space. LPA's received two waiver for the following Shared Program and Waiver for double playground capacity with a Reduced Space consideration. A new Application 200A was also submitted to reflect the changes in capacity. All three playgrounds will be used for the overall capacity determination for the preschool application. Primrose School is requesting 100 preschool children.

Applicant 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.

Exit interview conducted and report was reviewed with the facility representative Simaben Shah and Monica Thompson

facility representative where informed the application is pending management's final review and approval .



SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Stephanie Collins
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2