434417061-6-5-2023-07-CC-SYIP-CSHSG2-20230605135114

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417061
Report Date: 06/05/2023
Date Signed: 06/05/2023 01:51:19 PM

Document Has Been Signed on 06/05/2023 01:51 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:	SJB DANIEL LAIRON CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	434417061
ADMINISTRATOR:	REBECCA LARSEN		FACILITY TYPE:	850
ADDRESS:	3975 MIRA LOMA WAY, #A2, #A4		TELEPHONE:	(408) 414-2700
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95111
CAPACITY:	40	CENSUS: 0	DATE:	06/05/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Maria Velazquez and Melissa Leza		TIME COMPLETED:	02:00 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	Licensing Program Analysts (LPAs) Samantha Yip and Marilou Monico conducted an announced pre-licensing inspection. LPAs met with Regional Directors, Maria Velazquez and Program Director, Melissa Leza and explained the reason for the inspection. The purpose of this inspection is Applicant is applying for a preschool license with the toddler option. Applicant is applying for a capacity of 24 preschool children and 16 for the toddler option. The center is located on the Daniel Lairon Elementary School campus in Room A2 and Room A4. A2 will be used for toddler option and A4 will be used for the preschool program. There are areas to post required postings, such as notification of parent's rights, personal rights, daily activity schedule, sketch, car seat, and menu. There hours of operation are Monday through Friday 7AM to 6PM. There is working phone at the site, which is (408) 516-7200. LPAs toured the inside and outside of the facility. Measurements were conducted during today's inspection. Preschool Program The indoor measurements for the preschool program is as followed: A4 Room: (32.250 x 35.417 = 1, 142.198) minus encumbered space 51.167 = 1090.528 divided by 35 = 31 children The outdoor space is as followed: Preschool Yard: (44.383 x 28.250 = 1,252.407) + (70.167 x 112.33 = 7,882.069) = 9134.476 minus encumbered space 334.257 = 8,800.219 8,800.219 divided by 75 = 117 children ----------------continues of 809 dated 06/05/2023 page 2----------------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

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 4

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: SJB DANIEL LAIRON CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434417061
	VISIT DATE: 06/05/2023

NARRATIVE

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-----------------continuation of 809 dated 06/05/2023 page 1---------------------
Toddler Program
The indoor measurement for the toddler program is as followed:
Toddler Option- A2 Room: (35.500 x 32.417 = 1,150.803) minus encumbered space 155.926 = 994.877 divided by 35 = 28 children

The outdoor space for the toddler program is as followed:
Toddler Yard: [1/2(( 7.750 x 11.417) = 44.240] + (56.500 x 29.250 = 1652.625) + (15.917 x 10.917 = 173.765) + [1/2(9.417 x 21) = 98.878] = 1,969.508
1,969.508 divided by 75 = 26 children

There are 30 chairs, 5 tables, 24 cubbies, 25 cots, 2 toilets, and 3 sinks for the preschool program. There are toys and equipment for children, which are age-appropriate. LPA reminded that all disinfectant, cleaning supplies, or other items that could pose a risk to children need to be inaccessible. LPA also discussed that minimum temperature in the room, which is 68 degrees Fahrenheit. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. There is a first aid kit, which has all the required items.

For the toddler option, there are 20 chairs, 6 tables, 40 cubbies, 16 cots, 1 toilets, 1 potty chair, and 2 sinks. There are toys and equipment for children. There a partition that separates the room, which is at least 4 feet high. There is a changing table, which is within arms reach of a sink. Changing table has a padding at least one inch and a raised side that is at least 3 inches. There a trash can that has a tight fitted lid. Isolation area is in the staff office and they will use one of the toilets and sinks in the toddler room.

The outdoor space is fenced. There is a fence to separate the toddler yard and the preschool yard. There is a play structure in the preschool yard. Area around play structure have resilient material. There are toys and equipment for children. Shaded rest area is provided through canopy and trees. LPA discussed with Program Directors that children cannot commingle when outside including when going to the yard and back inside.

All meals and snacks are prepared and brought off-site. There is area to keep food warm and store any perishable food and drinks. Drinking water is provided through water cooler and cups. LPAs discussed that they have 180 days after licensure to receive lead testing for drinking water. Trash can for waste have tight fitted lids. LPA discussed with trash can for waste need to have a tight fitted lid.

------------------continuation of 809 dated 06/05/2023 page 3----------------------

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

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: SJB DANIEL LAIRON CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 434417061
	VISIT DATE: 06/05/2023

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--------------------continuation of 809 dated 06/05/2023 page 2--------------------
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation for IMS was 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 facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

There are no staff associated to facility roster. Facility representative was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

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 conducted and report was reviewed with Regional Director, Maria Velazquez and Program Director, Melissa Leza. LPAs advised facility representatives upon approval of Licensing Management, a license for a preschool center with the toddler option license will be granted and issued to Applicant and completion of the following:
- fingerprints transferred to facility
- obtaining a copy of granted fire clearance

SUPERVISOR'S NAME: Joel Segura	TELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Samantha Yip	TELEPHONE: (408) 529-8128
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4