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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417113
Report Date: 02/05/2025
Date Signed: 02/06/2025 08:35:45 AM

Document Has Been Signed on 02/06/2025 08:35 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LAUREL PLAY GARDENSFACILITY NUMBER:
434417113
ADMINISTRATOR/
DIRECTOR:		SOUVANNARY THONGMANIVONGFACILITY TYPE:
830
ADDRESS:1050 PARK AVENUETELEPHONE:
(408) 645-5783
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
02/05/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Rahul Beri.TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Anna Morales conducted a Case Management visit in response to a notification that was self reported by the facility to Licensing on 1/16/25. LPA met with Rahul Beri. The Infant License Capacity is 14, ages 0-2 years old. On 1/16/25, Facility informed Licensing that they removed the counters and bookshelves that previously separated the office area from the infant indoor play area, not seeking to increase the capacity and no structural changes were made. An updated Facility Sketch was ,also, submitted.
During today's visit, LPA measured the Infant Play Room. LPA observed with Rahul Beri, one Infant Room on the right side,and on the left side is the Infant Indoor Play area. In the Infant Indoor Play Area, LPA observed that there were no counters/bookshelves separating the room, giving the infants more space. LPA observed that no structural changes were made. On 11/28/23, a Fire Clearance was granted for a total capacity of 66: 14 infants and 66 preschool. Fire Inspector noted on the clearance," All rooms approved for intended use by children, Fire Clearance granted."
Indoor measurements are as follows per LPA Marilou Monico and LPM Gladys Kuizon report dated 10/5/2023:
Indoor Activity Space:
Infant Room:20.83x14.00 = 291.62 minus 61.79 (encumbered space)= 229.83
Infant Indoor Play measurements taken on today's inspection:
16.67x16.42=273.73 minus 9.32(encumbered space)=264.41
16.08x12.33=198.26 minus 7.00(encumbered space)=191.26
Total Infant Indoor Play=455.67
TOTAL INDOOR SPACE=685.50 sq ft divided 35=19 children.
LPA informed Mr. Beri that if he wishes to increase the capacity for 19 infants, he will have to submit an application, pay a increase capacity fee of $25.00, and submit an updated facility sketch. LPA informed him that a Fire Safety Inspection Request(STD850)will be submitted by Licensing for a Fire Clearance Approval.
No deficiencies were cited during today's visit.

NOTICE OF SITE VISIT WAS ISSUED AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Anna Morales
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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