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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417135
Report Date: 12/19/2023
Date Signed: 12/19/2023 11:24:08 AM

Document Has Been Signed on 12/19/2023 11:24 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:TESSELLATIONS CHILDREN'S CENTERFACILITY NUMBER:
434417135
ADMINISTRATOR:STEPHANIE HOLSONFACILITY TYPE:
850
ADDRESS:1170 YORKSHIRE DRIVETELEPHONE:
(650) 260-4409
CITY:CUPERTINOSTATE: CAZIP CODE:
95014
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 0DATE:
12/19/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Stephanie HolsonTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPA) Harsimran Kaur conducted an announced pre-licensing inspection. LPA met with Director, Stephanie Holson and explained the reason for the inspection. The purpose of this inspection is Applicant is applying for a preschool license. Applicant is applying for a capacity of 36 preschool children. The center is located on the Tessellation's School campus in Room 30/31.

There are areas to post required postings, such as notification of parent's rights, personal rights, daily activity schedule, sketch, car seat, and menu. There hours of operation are Monday through Friday 7:45 AM to 6PM. There is working phone at the site, which is 408-505-1087.

The following are indoor measurements and information:
Preschool Program

The Indoor total measurements contain a total of {1971.96} square feet, which will accommodate Applicant’s request for 36 children.

Outdoor total measurements contain a total of {6114.99} square feet, which will accommodate Applicant’s request for 36 children.

There are 40 chairs, 13 tables, 36 cubbies, 36 cots, 3 toilets, and 5 sinks for the preschool program. There are toys and equipment for children, which are age-appropriate. LPA reminded that all disinfectant, cleaning supplies, or other items that could pose a risk to children need to be inaccessible. LPA also discussed that minimum temperature in the room, which is 68 degrees Fahrenheit. There is fully charged fire extinguisher, smoke detector, and carbon monoxide detector. There is a first aid kit, which has all the required items.

The outdoor space is fenced. There is a fence to separate the preschool yard and extra space. Extra space is used for picnic and tricycle riding. Also there are 2 gates attach to that fence to get entrance for maintenance over the weekend. There is a play structure and sand box in the preschool yard. Area around play structure have resilient material. There are toys and equipment for children. Shaded rest area is provided through deck area and trees.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/19/2023
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: TESSELLATIONS CHILDREN'S CENTER
FACILITY NUMBER: 434417135
VISIT DATE: 12/19/2023
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All meals and snacks will be prepare by venders My Green Lunch, The Fruit Guys but parents can provide lunch and snacks to their children. Drinking water is provided through water bottles. LPA discussed that they have 180 days after licensure to receive lead testing for drinking water. Trash can for waste have tight fitted lids. There is refrigerator and dishwasher in the classroom.

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 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 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.

Exit interview conducted and report was reviewed with, Stephanie Holson Director. Copy of the report was provided. Final license determination will be made upon review by Licensing Program Manager.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC809 (FAS) - (06/04)
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