434417071-8-3-2023-07-CC-MSMS-CUCV3K-20230803160453

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417071
Report Date: 08/03/2023
Date Signed: 08/03/2023 04:04:57 PM

Document Has Been Signed on 08/03/2023 04:04 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:	LUCCIOLA ACADEMY		FACILITY NUMBER:	434417071
ADMINISTRATOR:	NOPPAKET PONGCHANA		FACILITY TYPE:	850
ADDRESS:	1711 HAMILTON AVENUE		TELEPHONE:	(661) 703-7818
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY: 106	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	08/03/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Noppaket Pongchana		TIME COMPLETED:	04:00 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) Mel Matos & Jessica Bongardt , met with Noppaket Pongchana, Applicant Representative/Director, for the purpose of conducting an announced prelicensing inspection The Applicant has applied for a preschool with a toddler option, (434417071), and an infant license (434417072) on the same site. The Preschool Program will operate Monday through Friday from 7:45 AM to 6:00 PM. The Preschool Program is applying for a capacity 24 preschool (toddler option) children ages 18 to 36 months and 77 preschool children ages 2 to 5 years of age. The Preschool Program with the toddler component (#434417071) will be utilizing Room 5 (Sycamore) & Room 6 (Sakura) - toddler component - and Rooms 1 (Sequoia), Room 2 (Ceibo), Room 3 (Baobab), and Room 4 (Banyan). LPAs toured and measured the indoor and outdoor areas of the Facility during today's inspection. INDOOR MEASUREMENTS: Room 1 (Sequoia): (28.250 x 21.833 = 616.782) + 13.250 x 22.500 = 298.125) = 914.907 minus (7.833 x 8.000 = 62.664 encumbered space) = 852.243 Room 2 (Ceibo): (8.333 x 9.750 = 81.246) + (29.500 x 18.500 = 575.250) = 656.496 Room 3 (Baobab): 26.250 x 16.583 = 435.303 Room 4 (Banyan): (13.583 x 8.250 = 112.059) + (29.583 x 29.417 = 870.243) = 982.302 minus (8.083 x 7.833 = 63.314 encumbered space) = 918.988 Room 5 (Sycamore - toddler option): (30.500 x 21.750 = 663.375) + (13.417 x 21.000 = 281.757) = 945.132 minus (13.583 x 7.333 = 99.604 encumbered space) = 845.528 Room 6 (Sakura - toddler option): (20.917 x 18.250 = 381.735) + (5.583 x 6.000 = 33.498) = 415.233 minus (1.667 x 13.000 = 21.671 encumbered space) = 393.562 TOTAL INDOOR SPACE PRESCHOOL: 2,863.030 sq. ft. divided by 35 = 81 children TOTAL INDOOR SPACE TODDLER OPTION: 1,239.090 sq. ft. divided by 35 = 35 children.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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: LUCCIOLA ACADEMY	FACILITY NUMBER: 434417071
	VISIT DATE: 08/03/2023

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

There are 3 toilets (45) and 5 sinks (75) available for the toddler option children. There are 6 toilets (90) and 8 sinks (120) available for the preschool children. Potty training will be provided by the Facility. There is no hot water available in the children's sinks. Staff have separate staff bathrooms on site that can be utilized by sick children if necessary. Sick children will be isolated in the director's office area of the Facility and isolation equipment is available.

The Facility has adequate heating/air conditioning in all classrooms. LPAs did not observe any fireplace or wall heater units in Rooms 1-6. Rooms 1-6 have appropriate lighting. First aid supplies are stored in each room and are inaccessible to the children. There are functioning fire/carbon monoxide detectors in each room. Noppaket states that there are no firearms or weapons on the premises.

LPAs note that Rooms 1-6 and the Preschool Playground is not fully set up with adequate equipment, supplies, and toys for the infant children. A follow up inspection will be required once all rooms are fully set up and functional.

OUTDOOR MEASUREMENTS:

Preschool Playground = 158.500 x 51.833 = 8,215.530 minus (26.500 x 26.667 = 706.667- encumbered space) = 7,508.863

TOTAL OUTDOOR SPACE: 7,508. 855 sq. ft. divided by 75 = 100 children.

LPAs observed that the preschool playground area is separate from the infant playground and surrounded by appropriate fencing. The toddler option will use the infant playground and a waiver for playground space and shared space will be submitted. Shade is provided by the umbrellas, trees, and building overhang. LPAs did not observe any bodies of water during today's inspection. Transportation will not be provided by the Facility. Facility needs to fence off area near the electrical power panel area to make such area off limits to children.

LPAs received a fire clearance approval from the San Jose Fire Department prior to today's inspection; however, LPAs are awaiting an updated fire clearance approval with the correct capacity of 77 preschool & 24 toddler option children.
Exit interview conducted and report was reviewed with Noppaket Pongchana, Applicant Representative/Director, and advised her that the following will be required prior to approval of a preschool license for 101 children (77 preschool & 24 toddler option).
1) Follow up inspection has been completed to verify that the Facility is fully set up with adequate equipment, supplies, and toys for the children.
2) The area near the electrical power panel in the preschool playground is made off limits to children.
3) Waiver for playground space and shared place has been submitted and approved.
4) Updated fire clearance approval for 101 children (77 preschool & 24 toddler option) has been received from the San Jose Fire Department.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2