434417067-1-31-2023-07-CC-CNEN-CNLSCX-20230131124617

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417067
Report Date: 01/31/2023
Date Signed: 01/31/2023 12:46:51 PM

Document Has Been Signed on 01/31/2023 12:46 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:	ACHIEVERS		FACILITY NUMBER:	434417067
ADMINISTRATOR:	DIVYA KOHLI		FACILITY TYPE:	850
ADDRESS:	404 EAST EVELYN AVENUE		TELEPHONE:	(510) 676-4649
CITY:	SUNNYVALE	STATE: CA	ZIP CODE:	94086
CAPACITY: 30	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/31/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Divya Kohli & Neeru Vermani		TIME COMPLETED:	01:00 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) Cortney Nelson & Mel Matos, conducted an announced prelicensing inspection at the Facility. LPAs met with Neeru Vermani, Applicant Representative, and Divya Kohli, Director, and explained the nature of today's inspection to them. The Applicant has applied for a license for 30 preschool children and a fire inspection approval from the Sunnyvale Department of Public Safety for 30 preschool children was received on October 27, 2022. The Preschool Center will operate Monday through Friday from 8:00AM to 6:00PM, serving Preschool children ages 2 years through Kindergarten. The Preschool program will be utilizing three (3) classrooms and an outdoor playground area. LPAs toured and measured the indoor and outdoor areas of the Facility with Neeru & Divya during today's inspection. INDOOR MEASUREMENTS ARE AS FOLLOWS: Classroom #1: 1) 11.333 x 15.167 = 171.887 minus (3.417 x 1.500 = 5.125) encumbered space = 166.762 2) 10.000 x 6.833 = 68.330 Classroom #2: 1) 17.250 x 15.167 = 204.199 minus (3.417 x 1.500 = 5.125) encumbered space = 198.994 2) 14.167 x 6.583 = 93.261 Classroom #3: 1) 28.33 x 13.500 = 382.495 minus (2.417 x 2.333 = 5.638) encumbered space = 376.857 2) 8.500 x 5.750 = 48.875 3) 15.667 x 6.583 = 103.135 Preschool Indoor Space Total = 1,056.214 sq. ft. divided 35 sq. ft. = 30 preschool children.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ACHIEVERS	FACILITY NUMBER: 434417067
	VISIT DATE: 01/31/2023

NARRATIVE

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There are three sinks (45) and three toilets (45) available for the preschool children. Two of the three sinks are located directly outside of the children's bathroom. There is no hot water (less than 120 degrees F) available in the children's sinks. LPAs observed soap dispensers and hand dryers near the children's bathroom. There is one separate staff bathroom, located near the front of the Facility, that will be utilized by sick children if necessary. Sick children will be isolated in the Office and isolation equipment will be provided. Potty training will be provided by the Facility.

LPAs reminded Neeru & Divya of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the facility, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12 month period, civil penalty amounts to $100.00 per person up to $3000.00 per person.

OUTDOOR MEASUREMENTS ARE AS FOLLOWS:

PRESCHOOL PLAYGROUND:

1) 26.750 x 36.333 = 971.907
2) 29.333 x 19.667 = 576.892

TOTAL OUTDOOR SPACE: 1,548.799 sq. ft. divided by 75 = 20 preschool children.

LPAs observed no fireplaces or wall heater units in the Facility. The Classrooms have appropriate lighting, heating, and air conditioning. First aid kit is stored in the Facility inaccessible to the children. The Director, Divya, has the full 15 hours of Health and Safety Training. The Facility has working smoke/carbon monoxide detectors and a centralized fire alarm system.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ACHIEVERS	FACILITY NUMBER: 434417067
	VISIT DATE: 01/31/2023

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be 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 IMS Medications (Inhalers and EpiPens only) will be stored in the kitchen cabinet, inaccessible to children.
There are 6 tables, 30 chairs, 27 cubbies, 10 hooks, 3 nap mats, and 27 cots available for the preschool children. There is adequate equipment, supplies and toys for the children in the Facility. Drinking water will be provided indoors via reusable water bottles and filtered tap water. LPAs advised required water lead testing within 180 days of receiving license for Child Care Centers. There is a working telephone at the site. The phone number is (408) 685-2289. Neeru states that there are no firearms or weapons on the premises.

The food preparation area (kitchen) is functional and has hot and cold running water, sink, refrigerator, and storage space for food supplies. The Facility will only provide AM/PM snack to the children. The children will be required to provide their own lunches. Cleaning and sanitation of dishes and utensils will be done via hand washing as necessary, however the facility is planning to primarily utilize disposable products such as utensils and plates. LPAs advised a solid waste containers with tight-fitting lid is needed in the Facility. Cleaning supplies are stored in the upper cabinets of the kitchen area, inaccessible to children.

Neeru Vermani, Applicant Representative, and Divya Kohli, Director, have obtained the Criminal Record and Child Abuse Index clearances. Divya has met the education and experience qualification requirements and have current Pediatric First Aid/CPR Certifications on file. Proof of completion of Preventative Health Practices and vaccination records for MMR, Tdap, and Influenza are on file.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ACHIEVERS	FACILITY NUMBER: 434417067
	VISIT DATE: 01/31/2023

NARRATIVE

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LPAs observed that the preschool playground area is surrounded by appropriate fencing. LPAs observed a play structure in the playground that is age appropriate & secure with wood chips (resilient materials) underneath and surrounding the structure. Shade is provided by the building overhang and large holly tree. LPAs advised Neeru that the holly tree needs to be regularly maintained to ensure that growth sprouts coming from the bottom of the tree with sharp leaves are not within reach of children and staff. Drinking water will be provided via children's reusable water bottles that Neeru and Divya state will be refilled prior to going outside. LPAs advised that additional toy and play equipment should be purchased for utilization while children are outside. There is a sandbox and play kitchen located outside for children's use. LPAs did not observe any bodies of water during today's inspection. Transportation will not be provided by the Facility.

LPAs discussed "zero tolerance" related regulations with Neeru and Divya and advised both of the assessment of an immediate $500 per day civil penalty for any violation of a "zero tolerance" related regulation. An ongoing civil penalty of $150 per day continues until the violation(s) is corrected.

LPAs conducted an exit Interview and advised Neeru and Divya that a license for 30 preschool children will be approved upon completion of the following items:

1) Purchase additional toys and play equipment for the playground area.
2) Staff and children's bathrooms have been labeled.
3) Hand dryer near the children's sinks, located outside the children's bathroom has been repaired or replaced with alternative such as paper towels.
4) Updated fire clearance has been received from the Sunnyvale Department of Public Safety.
5) Updated Indoor Facility sketch (LIC999) has been submitted.
6) Playground waiver has been received and reviewed by Licensing Program Manager.
7) Updated Application for a Child Care Center (LIC200A) with facility phone number included
8) Final review & approval by Licensing Program Manager.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC809 (FAS) - (06/04)

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