434417132-11-15-2023-07-CC-HKAR-CXLRU5-20231115121922

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417132
Report Date: 11/15/2023
Date Signed: 11/15/2023 12:20:50 PM

Document Has Been Signed on 11/15/2023 12:20 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	LITTLE VILLAGE PRESCHOOL, THE		FACILITY NUMBER:	434417132
ADMINISTRATOR:	CHANEL ROLAND		FACILITY TYPE:	830
ADDRESS:	14381 BERCAW LANE		TELEPHONE:	(408) 412-8655
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95124
CAPACITY: 12	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	11/15/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Evelyn Talavera		TIME COMPLETED:	12:30 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 (LPA) Harsimran Kaur and Licensing Program Manager Deborah Lowe met with Site Assistant Director, Evelyn Talavera, for the purpose of conducting a Prelicensing Inspection. Fire clearance was approved on 09/29/23. The facility has pending application for a infant license that will operate Monday through Friday from 7:00 AM to 6:00 PM, serving children ages 3 months to 24 months old. LPA/LPM toured the facility during today's inspection as well measured the space available for the children. Infant classroom is located in room 3 back of front lobby area. The following are indoor measurements and information: The Indoor total measurements contain a total of {519.68} square feet, which will accommodate Applicant’s request for 12 infants. The Infant Program has one sink (12) available for the children. LPA/LPM observed a diaper changing table in the Infant Room that is within arm's reach of a sink. Sick children will be isolated in the reception area and isolation equipment will be provided. LPA/LPM observed containers with tight-fitting lids for the disposal of solid waste and diapers. First aid supplies, medication, and cleaning products are stored in the upper cabinets in the Infant Room. LPA/LPM observed smoke and carbon monoxide detectors at the facility. The facility has central heating and air conditioning.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LITTLE VILLAGE PRESCHOOL, THE	FACILITY NUMBER: 434417132
	VISIT DATE: 11/15/2023

NARRATIVE

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LPA Kaur advised the facility must be kept free of flies, other insects & rodents. LPA/LPM observed that all furniture and equipment indoor are in good condition and safe for the children. Drinking water will be readily available for the children indoor via sippy cups and bottles. The parents will be providing snacks and lunch for the children. Facility provide snacks to the children. The kitchen is equipped with a sink that has hot and cold running water, crock pot for bottle warming, microwave, refrigerator. The kitchen has plenty of storage spaces. Disposable dishes and utensils will be utilized by the facility. In infant classroom 2 area rugs observed trip hazards.

There are 12 small chairs, 2 table, 3 feeding chairs, 4 cribs, 11 mats, and 12 cubbies available for the infants.

Outdoor total measurements contain a total of {1190.75} square feet, which will accommodate Applicant’s request for 12 infants.

LPA/LPM observed that the Infant Playground is surrounded by appropriate fencing and the outdoor surfaces are safe. LPA/LPM observed some part of fence has 6 inch of gap underneath the fence. Facility designated infant playground is located in front of the facility in garden area. Drinking water outdoor is provided via sippy cups and bottles. No bodies of water were observed.

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

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LITTLE VILLAGE PRESCHOOL, THE	FACILITY NUMBER: 434417132
	VISIT DATE: 11/15/2023

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. 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.
LPA/LPM discussed the safe sleep regulations with Site Director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA/LPM informed Site Director 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/LPM reviewed with Site Director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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. 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 communication.

The following corrections needs to be corrected.

1) Facility to submit application to decrease capacity for preschool to accommodate infant application.

2) Facility to provide shade in infant outdoor space located at the front garden.

3) Facility need to adjust open gap underneath the fence.

4) Secure area rugs.

Exit interview conducted and report was reviewed with Evelyn Talavera, Assistant Director. Copy of the report was provided. Final license determination will be made upon review by Licensing Program Manager and correction of the above issues.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

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