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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417071
Report Date: 08/15/2023
Date Signed: 08/15/2023 03:21:22 PM

Document Has Been Signed on 08/15/2023 03:21 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 ACADEMYFACILITY NUMBER:
434417071
ADMINISTRATOR:NOPPAKET PONGCHANAFACILITY TYPE:
850
ADDRESS:1711 HAMILTON AVENUETELEPHONE:
(661) 703-7818
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 106TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/15/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Noppaket PongchanaTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Mel Matos & Jessica Bongardt, met with Noppaket Pongchana, Applicant Representative/Director, for the purpose of conducting a follow up announced prelicensing inspection The Applicant has applied for an infant #434417072 and preschool (Rooms 2-5) with a toddler option (Room 5 & 6) #434417071 - license on the same site.

Previous prelicensing inspections were completed on August 3, 2023 & August 10, 2023 and Noppaket Pongchana, Applicant Representative/Director, was advised that the following would be required prior to approval of an infant license for 77 preschool & 24 infant/toddler children.

1) A waiver request for the shared playground space/lack of sufficient space with the infant children has been submitted & approved.
2) Updated fire clearance approval for 101 children has been received from the San Jose Fire Department.
3) Sufficient napping mats, tables, chairs, and hooks/cubbies for the capacity requested (101).
4) Trash cans with tight fitting lids have been purchased for Rooms 3-7.

There are 24 chairs, 5 tables, 24 mats, 16 cubbies, and 24 hooks for the infant/toddler children. There are 77 chairs, 20 tables, 77 mats, 8 cubbies, and 43 hooks for the preschool children. There is at one trash can with a tight fitting lids in each Room.

Waiver request for shared playground space/lack of sufficient space for the toddler playground and usage schedules were provided to LPAs. A fire clearance from San Jose Fire Department was received prior to today's inspection.

Exit interview conducted and report was reviewed with Applicant Representative/Director, Noppaket Pongchana. LPAs advised Noppaket that a license for 101 children (24 toddler option & 77 preschool) is approved effective today, August 15, 2023.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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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