<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417113
Report Date: 11/16/2023
Date Signed: 11/16/2023 03:42:54 PM

Document Has Been Signed on 11/16/2023 03:42 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:LAUREL PLAY GARDENSFACILITY NUMBER:
434417113
ADMINISTRATOR:SOUVANNARY THONGMANIVONGFACILITY TYPE:
830
ADDRESS:1050 PARK AVENUETELEPHONE:
(408) 645-5783
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/16/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Aakriti Beri & Rahul BeriTIME COMPLETED:
04:00 PM
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), Marilou Monico, conducted an unannounced Prelicensing Inspection. LPA met with Applicant Representative, Aakriti Beri, and CEO, Rahul Beri. An updated application was received from Applicant on October 20, 2023 requesting a capacity of 14 children, ages 0-2 years. An initial Prelicensing Inspection was conducted on October 5, 2023.

The following outdoor measurements were taken during the inspection:
INFANT PLAY YARD: 39.42 x 16.17 = 637.42
TOTAL INFANT OUTDOOR SPACE: 637.42 sq.ft. divided by 75 sq. ft. = 8 children

LPA observed the following:
1) At least four feet partition separating the crib area from the activity area in the infant room has been installed.
2) Partition/gate separating the activity area from the diaper changing/bathroom area has been installed.
3) A gate separating the Infant Indoor Play Room from the lobby/hallway.
4) Trash cans with tight fitting covers for the disposable of solid waste and diapers.
5) The faucet located in the kitchen has hot and cold running water.

The following items must be completed prior to licensure of 14 children in the Infant Program:
1) Fire clearance
2) Copy of Infant Needs and Services
3) List of furniture and play equipment
4) Waiver request to be licensed for 14 children even the playground is only measured for 8 children and playground schedule.
5) Photos showing that the Infant Play Yard is fully set-up.
6) Licensing Program Manager's review and approval.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Marilou Monico
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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 1