434417105-6-5-2023-07-CC-MSMS-CSHPDJ-20230605111336

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417105
Report Date: 06/05/2023
Date Signed: 06/05/2023 11:13:42 AM

Document Has Been Signed on 06/05/2023 11:13 AM - 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:	AGNEW EARLY LEARNING PROGRAM		FACILITY NUMBER:	434417105
ADMINISTRATOR:	NANCY MORIN-ROMAN		FACILITY TYPE:	830
ADDRESS:	3534 ZANKER ROAD # 112		TELEPHONE:	(669) 369-4185
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95134
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 12	CENSUS: 0	DATE:	06/05/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Jennifer Marfia & Natacha Costa		TIME COMPLETED:	11:35 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 Analyst (LPA) Mel Matos conducted an unannounced prelicensing inspection in response to an application submitted by the Santa Clara Unified School District requesting an infant license at 3534 Zanker Road #112, San Jose, CA 95134. LPA met with Jennifer Marfia, program director, and Natacha Costa, director, and explained the nature of today's inspection to them. The Facility is located on the premises of Agnew Elementary School. The Facility also has a licensed preschool program (Facility #: 434417019) on the same premises in Rooms in Rooms D103 & D106. The Infant Program will be open Monday through Friday from 7:15AM to 5:30PM and will serve children ages 0 - 2 years old in Room D112. Facility contact number: 669-369-4185. A fire clearance approval from the Santa Clara Fire Department was granted for 12 infants which was received prior to today's inspection. LPA toured and measured the indoor and outdoor areas of the facility during today's inspection. Indoor Activity Space: ROOM D112: 29.833 x 29.833 = 890.007 sq ft minus (23.500 x 7.333 = 172.325 - crib area/ encumbered space) = 717.682 *TOTAL INDOOR SPACE = 717.682 sq. ft. divided by 35 = 20 infant children* The Facility has 3 sinks (45) and 1 toilet (15) available for the infant children in Room D112. The sinks used by the infant children only have cold running water. Staff have a separate bathroom which is located directly across from Room D112. Facility has a separate bathroom (staff bathroom) for sick children to use if needed. Sick children will be isolated in the director's office and the isolation equipment will be provided. Staff and children's bathrooms are clean, sanitary, and operable.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

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: AGNEW EARLY LEARNING PROGRAM	FACILITY NUMBER: 434417105
	VISIT DATE: 06/05/2023

NARRATIVE

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There is 3 tables, 12 chairs, 12 cubbies, 6 cribs, and 7 napping cots for the infant children. There is adequate equipment, supplies, and toys for the infant children in Room D112. LPA observed a changing table in Room D112 that has raised sides (3 inches in height) and is within an arm's reach of a sink. LPA observed containers with tight-fitting lids for solid waste and diaper disposal in Room D112. First aid supplies are stored in Room D112 and are inaccessible to children. Cleaning supplies are stored on high shelves/locked cabinets and in the off-limits janitor closet located outside of the classroom.

LPA observed functioning smoke/carbon monoxide detectors in Room D112. The Facility has central heating/air conditioning. Facility will not be administering any medication at this time. LPA did not observe any fireplaces or wall heaters at the Facility. Natacha states that there are no firearms on the premises.

LPA observed that the facility is clean. Director understands that the Facility must be kept free of flies, other insects & rodents. LPA observed that all furniture and equipment are in good condition and safe for the children. Drinking water will be readily available for the children indoors refilling water station, sippie cups, and reusable water bottles.

The Facility will serve breakfast and AM/PM snacks to the older infant children. Parents will be required to provide lunch for the older infant children. There is an off-limits kitchen for food preparation, located near the reception area of the Facility. The kitchen is clean and equipped with hot and cold running water, sink, refrigerator, microwave, oven range, and storage space for food. Disposable utensils and plates will be utilized by the Facility.
Outdoor Activity Space:

Preschool Playground: 107.750 x 60.333 = 6,500.880 - (9.833 x 13.333 = 131.103 - encumbered space) = 6,369.777

TOTAL OUTDOOR SPACE = 6,369.777 divided by 75 = 84 children

The playground will be shared with the preschool program on rotating schedules. A waiver request along with preschool & infant schedules was provided to LPA prior to today's inspection. The playground is surrounded by appropriate fencing. LPA observed a storage closet and that is off limits to children. The areas around and under the play structure are cushioned with material (Play N Pour rubber surfacing) that absorbs falls.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

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: AGNEW EARLY LEARNING PROGRAM	FACILITY NUMBER: 434417105
	VISIT DATE: 06/05/2023

NARRATIVE

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Shade is provided by canopies and outdoor patios in the playground. There is adequate equipment and toys for children outdoors. Drinking water will be provided outdoors via water refilling station, sippie cups, and reusable water bottles. There were no bodies of water observed. The Facility will not provide transportation.

Fingerprint clearances for individuals at this facility who require caregiver background checks are issued by the State Department of Education and/or County Office of Education and do not come under the jurisdiction of Community Care Licensing division.

LPA discussed the safe sleep regulations with director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed owner of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA conducted an exit Interview and advised Jennifer Marfia, program director, and Natacha Costa, Director that a license for 12 infant children is approved effective today, June 5, 2023.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 06/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023

LIC809 (FAS) - (06/04)

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