434417066-5-25-2023-07-CC-ALOZ-CS6NS8-20230525104242

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417066
Report Date: 05/25/2023
Date Signed: 05/25/2023 10:42:47 AM

Document Has Been Signed on 05/25/2023 10:42 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	GREEN KIDS DAYCARE CENTER		FACILITY NUMBER:	434417066
ADMINISTRATOR:	JI SUN LEE		FACILITY TYPE:	850
ADDRESS:	5150 CAMDEN AVENUE		TELEPHONE:	(408) 394-1385
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY: 15	TOTAL ENROLLED CHILDREN: 6	CENSUS: 5	DATE:	05/25/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ji Sun Lee		TIME COMPLETED:	10:55 AM

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), Ashley Lopez and Marilou Monico conducted an unannounced case management inspection today and met with Site Director, Ji Sun Lee. The purpose of today's case management is due to the facility's request to increase the capacity from 15 to 30 children. LPAs toured the indoor and outdoor areas. *Indoor measurements taken by LPAs Cervantes and Dillon on 03/14/23:* 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 sinks (30) and 2 toilets (30) available for the children in Building C. Staff bathrooms (Men and Women) are located in Building B. Sick children will use the staff bathroom (Women) if needed. Sick children will be isolated in Building B Lobby adjacent to the staff bathrooms and will be accompanied by a staff member. *Continued on next page*

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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: GREEN KIDS DAYCARE CENTER	FACILITY NUMBER: 434417066
	VISIT DATE: 05/25/2023

NARRATIVE

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There are 44 chairs, 8 tables, 32 cots, and 43 cubbies available for the children. Drinking water indoor is via water dispenser and individual water bottles. LPAs observed functioning smoke and carbon monoxide detectors at the facility.

Outdoor measurements were taken by LPAs Cervantes and Dillon on 03//14/23:
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. Playground 1 can accommodate a maximum capacity of 11 children and Playground 2 for a maximum of 15 children. There are climbing structures with rubber tiles and rubber mulch as resilient material. There were no bodies of water observed. Shade is provided through canopies. Drinking water outdoor is via pitchers and individual water bottles. There is a working telephone number for the center which is (408) 394-1385.

Fire clearance for 30 children was granted on April 12, 2023.

Exit interview conducted and report was reviewed with Site Director, Ji Sun Lee, and advised her that a license for 30 children in the preschool program will be submitted to Licensing Management for final stage of approval.

There were no deficiencies cited during today's inspection.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Ashley Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC809 (FAS) - (06/04)

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