434417025-9-23-2022-07-CC-PHEZ-CJJRU3-20220923131914

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417025
Report Date: 09/23/2022
Date Signed: 09/23/2022 01:19:23 PM

Document Has Been Signed on 09/23/2022 01:19 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-DAY CARE, 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:	(408) 685-7133
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY: 100	TOTAL ENROLLED CHILDREN: 100	CENSUS:	DATE:	09/23/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Monica Thompson		TIME COMPLETED:	01:40 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	On 9/23/2022 LPA, Pete Hernandez, and RM, Anthony Studebaker, met with Licensee, Sima Shah, and Director, Monica Thompson. The purpose of the Case Management Licensee Initiated Inspection is to evaluate the Licensee's application request for an addition of a Toddler Component to the Preschool. The following indoor measurements were taken from a prior pre licensing inspection dated 4/13/2022 (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. The total space allowable for the Toddler Component requested in the application dated 8/8/2022 is 34 children. Based on the RM's and LPA's evaluation, 34 children is the total number of children approved based on allowable space. This calculation was assessed by combining current intended indoor and outdoor space for the Toddler Component. LPA explained that a creating a special program for children who are between 18 months and 36 months of age is a Toddler Component. The children in the Toddler Component must have permission from the child's authorized representative. A Toddler program shall be conducted in areas physically separate from those used by younger or older children. LPA also discussed that rooms EPS 1 and EPS 2 are to be used solely for the purpose of the Toddler Component and not for Preschool or Infant programs.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: PRIMROSE SCHOOL OF CUPERTINO	FACILITY NUMBER: 434417025
	VISIT DATE: 09/23/2022

NARRATIVE

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LPA reminded the Licensee that the total capacity allowable starting 10/1/2022 will be limited to 66 Preschool Children. Under this license it is agreed that Preschool Children will only occupy rooms C1, C2, D1, and D2.

Total capacity shall be 34 Toddler Component children and 66 preschool children for a total of 100 children in care under the preschool license.

LPA provided a copy of Title 22 regulation, 101216.4, Preschool Program with Toddler Component with the Director.

This Toddler Component has been approved on 9/23/2022 for 34 children ages 18 to 36 months by Management. Licensee has requested that the Toddler Component be effective 10/1/2022.

Based on the LPA and RM's observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with the licensee. A copy of this report was discussed and left with the Licensee Representative, Sima Shah, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC809 (FAS) - (06/04)

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