434417124-9-27-2023-07-CC-YHUG-CW3T2N-20230927142100

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417124
Report Date: 09/27/2023
Date Signed: 09/27/2023 02:21:41 PM

Document Has Been Signed on 09/27/2023 02:21 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ICARE CHILDREN'S HOUSE MONTESSORI PRESCHOOL		FACILITY NUMBER:	434417124
ADMINISTRATOR:	YAN GONG		FACILITY TYPE:	850
ADDRESS:	2555 MOORPARK AVENUE		TELEPHONE:	(408) 398-2033
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95128
CAPACITY: 96	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/27/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Yan Gong		TIME COMPLETED:	03:00 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 Analysts (LPAs) Oscar Huang and Sheena Chin, conducted an announced pre-licensing inspection to the Facility today. LPAs met with Yan Gong, Applicant Representative/Site Director, and explained the nature of today's inspection. The facility will operate Monday through Friday from 07:30 AM to 06:30PM, serving children ages 2 years to 5 years old and with the toddler option from ages 18 months to 36 months. LPAs toured the indoor and outdoor areas of the Facility during today's inspection, measurements were using data taken on 10/19/2021 by LPAs Dung Mac and Marilou Monico. INDOOR MEASUREMENTS FOR PRESCHOOL ARE AS FOLLOWS: Room 1 = (16.750 x 11.250) + (31.750 x 14.250) - (10.750 x 5.083) encumbered = 640.874 - 54.642 = 586.232 Room 4 = (21.000 x 17.250) - (2.000 x 9.000) encumbered = 362.25 - 18.000 = 344.250 Room 5 = 22.750 x 12.417 = 283.486 Room 6 = (22.833 x 22.167) - (1.750 x 0.750) encumber = 506.139 - 1.312 = 504.827 Room 7 = (9.250 x 13.000) + (7.000 x 6.667) + (10.000 x 7.917) = 250.25 + 79.17 + 46.669 = 376.089 Preschool Indoor Space Total = 2094.884 sq. ft. divided 35 sq. ft. = 59 children Continuation on Page # 2

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ICARE CHILDREN'S HOUSE MONTESSORI PRESCHOOL	FACILITY NUMBER: 434417124
	VISIT DATE: 09/27/2023

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
26
27
28
29
30
31
32

P2.
There are 6 sinks (90), 4 toilets (60), and 2 urinals (30) available for preschool children to use. The sinks have cold and hot running water. There are 10 tables, 30 mats, 30 chairs, and 60 cubbies.

INDOOR MEASUREMENTS FOR TODDLER OPTION ARE AS FOLLOWS:

Room 2 = (15.917 x 12.667) + (20.500 x 13.750) - (2.250 x 1.083) encumbered
= 483.495 - 2.436 = 481.059
Room 3 = (21.333 x 19.333) - (2.500 x 1) encumbered
= 412.430 - 45.841 = 366.589

Toddler Indoor Space Total = 847.648 sq. ft. divided 35 sq. ft. = 24 toddlers

There are 3 sinks (45) and 1 toilet (15) available for toddlers to use. The sinks have cold and hot running water. There are 3 tables, 19 mats, 12 chairs, and 18 cubbies.

Some of the children will be attending on a part-time basis. LPAs observed containers with tight-fitting lids for solid waste. The Facility has barricaded wall heaters, space heaters, and air-conditioning. All classrooms have appropriate lighting. Drinking water is available via individual water bottle indoors and water dispenser and plastic cups. LPAs discussed that the facility has 180 days after licensure to receive lead testing for drinking water.

LPAs observed functioning smoke/carbon monoxide detectors at the facility. Cleaning supplies will be stored on high shelves in kitchen inaccessible to children. First aid supplies and medications will be stored in the office. There is adequate equipment, supplies and toys for the children in each classroom. The facility has a separate staff bathroom located in Room 1 that will be utilized by sick children if necessary. Sick children will be isolated in the office and isolation equipment will be provided.
Continuation on Page # 3

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ICARE CHILDREN'S HOUSE MONTESSORI PRESCHOOL	FACILITY NUMBER: 434417124
	VISIT DATE: 09/27/2023

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
26
27
28
29
30
31
32

P3.
The facility will provide AM/PM snacks. Lunch will be provided by the facility via a licensed restaurant. There is a kitchen on-site and the food preparation area is functional and has hot and cold running water, sink, microwave, and storage space for food. Cleaning and sanitation of dishes and utensils will be done via dishwasher. Plastic utensils and plates will be utilized by the Facility. Transportation will not be provided. Applicant Yan states that there are no weapons on the premises.

OUTDOOR MEASUREMENTS:
(63.000 X 105.000) - 432.331 (encumbered) = 6,515.000 minus 432.331 (encumbered space) = 6182.669
TOTAL OUTDOOR SPACE =6,182.669 sq. ft. divided by 75 sq. ft. = 82 children

The playground area utilized by children is surrounded by appropriate fencing. LPAs observed that the outdoor equipment is age appropriate. There are climbing structures in the yard with wood chips for resilient material. Shade is provided by large trees, canopies, and building overhangs. Drinking water is provided by individual water bottles. LPAs observed no bodies of water. Applicant stated that the outdoor playground will be used for both preschool and toddler option programs in different sharing time schedule.

Yan Gong, Applicant Representative/Site Director, have obtained a Criminal Records Clearance and Child Abuse Index Checks. Yan's Pediatric First Aid/CPR Certifications expire April 2025. Yan has proof of completion of Preventative Health Practices and immunization in Measles and Pertussis, Influenza, and TB negative test on file.

LPAs reminded Yan of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the facility, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day up to $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person up to $3000.00 per person.
Continuation on Page # 4

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ICARE CHILDREN'S HOUSE MONTESSORI PRESCHOOL	FACILITY NUMBER: 434417124
	VISIT DATE: 09/27/2023

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
26
27
28
29
30
31
32

P4.
This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS was submitted to the Department and on file. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPAs reviewed with facility representative the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Only the applicant is associated to facility roster. Applicant 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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.

Continuation on Page # 5

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ICARE CHILDREN'S HOUSE MONTESSORI PRESCHOOL	FACILITY NUMBER: 434417124
	VISIT DATE: 09/27/2023

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
26
27
28
29
30
31
32

P5.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

LPAs conducted an exit Interview and advised Yan Gong that a license for 83 preschool children will be approved upon completion of the following items and management review and approval:

1) To revise the Application for Child Care Center License (LIC 200A) to change the requested capacity from 96 to 83 children (59 preschoolers & 24 toddler).
2) To submit a waiver request for outdoor playground time sharing between preschool and toddler programs.
3) To relocate two changing tables to have arm's reach to the sinks.
4) To provide proofs for purchasing additional furniture: 1 table, 41 chairs, 34 mats, 6 cubes.
5) To provide proof for purchasing a complete first-aid kit.
6) The current facility (Elite International) to volunteer surrendering its licensee along with a closing statement to the department.
7) The current facility (Elite International) to provide the termination of lease agreement with the landlord.
8) Applicant Yan to volunteer surrendering her licensee along with a closing statement to the department.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC809 (FAS) - (06/04)

Page: 5 of 5