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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417071
Report Date: 11/09/2023
Date Signed: 11/09/2023 03:05:07 PM

Document Has Been Signed on 11/09/2023 03:05 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: 26CENSUS: 21DATE:
11/09/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Noppaket Pongchana TIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Mel Matos & Jessica Bongardt , met with Noppaket Pongchana, Licensee Representative/preschool director for the purpose of conducting an unannounced case inspection in response to a decrease of capacity from 106 to 104 children (preschool = 80 & toddler option = 24) and to remove Room 6 (Sakura) from the current license. There is an infant (434417072) and preschool license with a toddler option (434417071) on the same site.

The preschool program operates Monday through Friday from 7:45 AM to 6:00 PM. The preschool program with the toddler option (#434417071) is currently licensed in the following Rooms: Room 5 (Sycamore) & Room 6 (Sakura) - toddler option - and Rooms 1 (Sequoia), Room 2 (Ceibo), Room 3 (Baobab), and Room 4 (Banyan). The preschool license will be keeping only Room 5 (Sycamore) for the toddler option. Preschool Rooms 1-4 will remain unchanged.

LPAs toured the indoor and outdoor areas of the Facility during today's inspection. Measurements were previously taken by LPAs Matos and Bongardt on August 3, 2023.

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

TOTAL INDOOR SPACE PRESCHOOL: 2,863.030 sq. ft. divided by 35 = 81 children
TOTAL INDOOR SPACE TODDLER OPTION: 845.528 sq. ft. divided by 35 = 24 children.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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: LUCCIOLA ACADEMY
FACILITY NUMBER: 434417071
VISIT DATE: 11/09/2023
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There are 2 toilets (30) and 2 sinks (30) 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.

There is adequate equipment, supplies and toys for the children based on the capacity requested. Noppaket understands that walkers, and items of similar nature are not permitted. LPAs observed appropriate changing tables that have raised sides (3 inches in height) and are within an arm's reach of a sink in Room 5.

Noppaket understands that all children must be under direct visual supervision at all times, including nap times. Noppaket understands that the Facility must maintain napping logs for any toddler children under 24 months of age. Drinking water will be provided indoors/outdoors via water jugs/sippie cups/reusable water bottles/cups of water. There is a working telephone at the Facility. The phone number is 408-300-1646.

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.

Noppaket Pongchana, Licensee representative/director, was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

A fire clearance from San Jose Fire Department was received prior to today's inspection.

Exit interview conducted and report was reviewed with Licensee Representative/director, Noppaket Pongchana. LPAs advised Noppaket that a license for 104 children (80 preschool & 24 toddler) is approved today, August 15, 2023.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023
LIC809 (FAS) - (06/04)
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