<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417066
Report Date: 03/14/2023
Date Signed: 03/14/2023 12:28:45 PM

Document Has Been Signed on 03/14/2023 12:28 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:GREEN KIDS DAYCARE CENTERFACILITY NUMBER:
434417066
ADMINISTRATOR:JI SUN LEEFACILITY TYPE:
850
ADDRESS:5150 CAMDEN AVENUETELEPHONE:
(408) 394-1385
CITY:SAN JOSESTATE: CAZIP CODE:
95124
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
03/14/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Ji Sun LeeTIME COMPLETED:
12:35 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 3/14/2023 at 09:00 AM, Licensing Program Analysts (LPAs) Susy Cervantes and Jovani Dillon met with Ji Sun Lee, Director and Kwang Lee, Board member for a pre-licensing visit. LPAs toured the facility both inside and out as well as measured the indoor and outdoor spaces. The following indoor measurements were taken today:

ROOM A 18.667 x 17.25 = 322. 01
ROOM B 18.667 x 17.25 = 322.01 minus 8.55 (encumbered space) = 313.46
ROOM C 31 x 19.25 = 596.75 minus 20.58 (encumbered space) = 576.17
ROOM D 15.167 x 13.083 = 198.43
TOTAL PRESCHOOL INDOOR SPACE: 1410.06 sq. ft. divided by 35 = 40 children.

There are 2 toilets and 2 sinks (30) available for the children in building C and 3 toilets and 2 sinks (30) available for the children in Building B. Only cold water is available in the children's sinks. There is one separate staff bathroom with 3 toilets, 2 urinals, and 2 sinks which is located in building B and will be used by the sick child. The sick child will be isolated in the Director's office and isolation equipment is provided. LPAs observed a blocked off fireplaces and no wall heaters at the facility. Air conditioning is provided in all rooms. The rooms have appropriate lighting. The center will be administering medication with a doctor's note only, medication will be stored in the office. First aid supplies are stored in each room, they are adequate and are inaccessible to children. Carbon monoxide detector is operable. There are 4 fire extinguishers. Cleaning supplies are stored in a locked closet in classroom A and the alarm panel closet. The center will be providing snacks for the children and snacks will be prepared in the staff room. Meals will be provided through a catering service that will deliver daily, company has not been selected yet. The staff room is equipped with refrigerator, microwave, and sink with hot and cold running water.

Continues on report dated 03/14/2023_______________________________________ pg 1/2
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
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 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: GREEN KIDS DAYCARE CENTER
FACILITY NUMBER: 434417066
VISIT DATE: 03/14/2023
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
26
27
28
29
30
31
32
Continuation of report dated 03/14/2023_______________________________________ pg 2/2

Disposable dishes and cups will be utilized for the children. LPAs observed solid waste container with tight-fitting lid in the staff room and classrooms. There are 47 cubbies, 9 tables of different sizes, 47 chairs, and 32 cots. Some children will be coming to the center on a part-time basis. Drinking water is available indoor and outdoor by water pitchers and water bottles that children can bring.

Outdoor measurements and information are:

PRESCHOOL PLAYGROUND
PLAYGROUND 1 39.333 x 21.167 = 832.56
PLAYGROUND 2 48.417 x 23.25 = 1125.70
Playground total = 1958.26
TOTAL PRESCHOOL OUTDOOR SPACE: 1,958.26 sq. ft. divided by 75 = 26 children.

The playgrounds are surrounded by appropriate fencing. There are climbing structures with pour play and rubber mulch as resilient material. LPAs observed no bodies of water. No transportation is provided by the school. Shade is provided through canopies. There is one working telephone number for the center which is (408) 394-1385.

A review of staff records on 03/14/2023 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. Director and board member 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.

An exit interview was conducted prior to the conclusion of today's visit and LPA advised Ji Sun Lee and Kwang Lee that a license for 20 children is approved pending the following:

-Management's approval
SUPERVISORS NAME: Mary Segura
LICENSING EVALUATOR NAME: Susy Cervantes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2