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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417067
Report Date: 02/15/2023
Date Signed: 02/15/2023 09:54:19 AM

Document Has Been Signed on 02/15/2023 09:54 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ACHIEVERSFACILITY NUMBER:
434417067
ADMINISTRATOR:DIVYA KOHLIFACILITY TYPE:
850
ADDRESS:404 EAST EVELYN AVENUETELEPHONE:
(408) 685-2289
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
02/15/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Divya KohliTIME COMPLETED:
10:15 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 Analyst (LPA) Mel Matos met with Divya Kohli, director, for an announced follow up prelicensing inspection. The initial prelicensing inspection was completed on January 31, 2023 by LPAs Nelson and Matos and the Facility was provided with a list of items that needed to be completed prior to approval of the preschool license for 30 preschool children.

LPA notes that the Facility has designated a part of Classroom #2 as an isolation area in case a child needs to be isolated from the other preschool children. Facility measurements were originally taken on January 31, 2023 by LPAs Nelson and Matos. LPA Matos remeasured Classroom #2 during today's inspection to account for the isolation area space and adjusted encumbered space. Measurements for Classrooms #1 & #3 remain unchanged. An updated Facility sketch was provided to LPA during today's inspection. An updated Application for a Child Care Center License (LIC 200A) and playground waiver request was received prior to today's inspection.

LPA Matos also toured the Facility and observed that the staff & children's bathrooms have been labeled, the hand dryer near the children's sinks is working, and that there are sufficient toys & play equipment in the playground area.

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 (5.000 x 2.000 = 10.000) encumbered space = 194.199
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 = 1,051.419 sq. ft. divided 35 sq. ft. = 30 preschool children.

LPA Matos conducted an exit interview and advised Divya that a license for 30 preschool children will be completed upon completion of the following items:

1) Updated fire clearance has been received.
2) Playground waiver has been reviewed and approved by Licensing Program Manager.
3) Final review & approval by Licensing Program Manager.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 1