434417072-11-9-2023-07-CC-MSMS-CXEUZP-20231109150152

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417072
Report Date: 11/09/2023
Date Signed: 11/09/2023 03:01:56 PM

Document Has Been Signed on 11/09/2023 03:01 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:	434417072
ADMINISTRATOR:	ANNA KATRINA OWENS		FACILITY TYPE:	830
ADDRESS:	1711 HAMILTON AVENUE		TELEPHONE:	(661) 703-7818
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY:	21	CENSUS: 7	DATE:	11/09/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Noppaket Pongchana & Anna Katrina Owens		TIME COMPLETED:	11:30 AM

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, Licensee Representative, and Anna Katrina Owens, infant director, for the purpose of conducting an unannounced case inspection in response to an increase of capacity from 21 to 24 infant children and to add Room 6 (Sakura) to the current license. There is an infant (434417072) and preschool license with a toddler option (434417071) on the same site. The infant program operates Monday through Friday from 7:45 AM to 6:00 PM. The infant program is currently licensed in Room 7 (Teak) and serves ages 0 to 24 months. 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 dropping Room 6 (Sakura) from the license and 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 6 (Sakura): (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 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: 904.795 sq. ft. divided by 35 = 25 children There are 3 toilets (45) and 4 sinks (60) available for the infant children. No potty training is 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 infant children in Rooms 6 & 7. There 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 Rooms 6 & 7. There is a separate sleeping (crib) area in Room 7 (separate from the indoor activity space) with a total of 3 cribs.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
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: 434417072
	VISIT DATE: 11/09/2023

NARRATIVE

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Noppaket understands that the infants must be under direct visual supervision at all times, including nap times, in the separate sleeping (crib) area. Drinking water will be provided indoors/outdoors via water jugs/sippie cups/cups of water. There is a working telephone at the Facility. The phone number is 408-300-1646.

Outdoor measurements:

Infant Playground = 58.250 x 16.667 = 970.852 minus (1.667 x 21.167 = 35.285) = 935.567

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. There is sufficient equipment, supplies, and toys in the infant playground. The preschool (toddler option - Facility #434417071 will be sharing the playground area with the children from infant program at different intervals throughout the day. Waiver request for shared playground space with the toddler option children (under preschool license) and usage schedules were provided prior to today's inspection. 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.

Noppaket 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 24 infant children in Room 6 (Sakura) and Room 7 (Teak) is approved today, August 15, 2023.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2158
LICENSING EVALUATOR NAME: Melvin S Matos	TELEPHONE: (408) 334-8554
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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