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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417072
Report Date: 08/03/2023
Date Signed: 08/03/2023 04:07:15 PM

Document Has Been Signed on 08/03/2023 04:07 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:
434417072
ADMINISTRATOR:NOPPAKET PONGCHANAFACILITY TYPE:
830
ADDRESS:1711 HAMILTON AVENUETELEPHONE:
(661) 703-7818
CITY:SAN JOSESTATE: CAZIP CODE:
95125
CAPACITY: 21TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/03/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Noppaket PongchanaTIME COMPLETED:
12:00 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 an announced prelicensing inspection The Applicant has applied for an infant, (434417072), and preschool license with a toddler option (434417071) on the same site.
The Infant Program will operate Monday through Friday from 7:45 AM to 6:00 PM. The Infant Program is applying for a capacity of 12 infant children ages 0 to 24 months. 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 7 (Teak): (13.833 x 5.167 = 71.475) + (24.000 x 20.667 = 496.008) minus (5.000 x 11.250 = 56.250 encumbered space) = 511.233

TOTAL INDOOR SPACE: 511.233 sq. ft. divided by 35 = 14 children

There are 2 toilets (30) and 2 sinks (30) available for the preschool children. No 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.
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: 434417072
VISIT DATE: 08/03/2023
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The Facility has adequate heating/air conditioning in all classrooms. LPAs did not observe any fireplace or wall heater units in Room 7 (Teak). Room 7 (Teak) has appropriate lighting. First aid supplies are stored in Room 7 and are inaccessible to the infant children. There are functioning fire/carbon monoxide detectors in Room 7 (Teak). Noppaket states that there are no firearms or weapons on the premises.

LPAs note that Room 7(Teak) and the Infant Playground is not fully set up with adequate equipment, supplies, and toys for the infant children. A follow up inspection will be required once the room is fully set up and functional.

OUTDOOR MEASUREMENTS:

Infant Playground = 58.250 x 16.667 = 970.852 minus (1.667 x 21.167 = 35.285) =

TOTAL OUTDOOR SPACE: 935.567 sq. ft. divided by 75 = 12 children.

LPAs observed that the infant playground area is separate from the preschool playground and surrounded by appropriate fencing. The preschool (toddler option children - Facility #434417071 will be sharing the playground area with the children from Infant Program at different intervals throughout the day. A waiver request for the shared playground space with the toddler option children will be required. Shade is provided by the umbrellas and building overhang. LPAs did not observe any bodies of water during today's inspection. Transportation will not be provided by the Facility.

A Waiver request for the shared playground space with the toddler option children will be required.

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 12 infant 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 an infant license for 12 children.
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) A waiver request for the shared playground space with the toddler option children has been submitted & approved.
3) Updated fire clearance approval for 12 infant children 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)
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