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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417072
Report Date: 08/15/2023
Date Signed: 08/15/2023 03:12:44 PM

Document Has Been Signed on 08/15/2023 03:12 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:
08/15/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Noppaket PongchanaTIME COMPLETED:
01:45 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 license with a toddler option (#434417071) 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 12 children.

1) A waiver request for the shared playground space with the toddler option children has been submitted & approved.
2) Updated fire clearance approval for 12 infant children has been received from the San Jose Fire Department.
3) Napping mats are available for the infants that don't require a crib.
4) Trash cans with tight fitting lids have been purchased for Room 7.

LPAs toured Room 7 during today's inspection. There are 13 chairs, 3 tables, 8 cubbies, 8 mats, and 12 hooks for the infant children. There is adequate equipment, supplies and toys for the infant children Room 7. There are at least two trash cans with tight fitting lids in Room 7. Noppaket understands that walkers, and items of similar nature are not permitted. LPAs observed appropriate one changing table that has raised sides (3 inches in height) and is within an arm's reach of a sink in Room 7. There is a separate sleeping (crib) area in Room 7 (separate from the indoor activity space) with a total of 4 cribs.

Waiver request for shared playground space with the toddler option children (under preschool license) 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 12 infant children is approved 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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