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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417094
Report Date: 08/01/2023
Date Signed: 08/01/2023 11:17:39 AM

Document Has Been Signed on 08/01/2023 11:17 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SPROUTS SC HAPPY VALLEYFACILITY NUMBER:
444417094
ADMINISTRATOR:SHANNON BLAKEFACILITY TYPE:
840
ADDRESS:3125 BRANCIFORTE DRIVETELEPHONE:
(415) 722-6339
CITY:SANTA CRUZSTATE: CAZIP CODE:
95065
CAPACITY: 50TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/01/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Shannon Blake & Jordan BemelTIME COMPLETED:
11:27 AM
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), Cortney Nelson, met with Applicant Representatives, Jordan Bemel and Shannon Blake, for an announced pre-licensing inspection. The Applicant, Sprouts SC LLC, is applying for a school-age license with a capacity of 50, serving ages 4.9 to 12 years old. The facility is located at Happy Valley School located in the multipurpose room and art/music room and a fire clearance was approved on 5/26/2023 by Branciforte Fire Protection. The facility will be open Monday-Thursday 1:00-6:00pm and Fridays 12:00-6:00pm.

Sprouts SC Happy Valley will be operating on a functioning school site and is exempt from square-footage for indoor and outdoor activity space, sink/toilet, fencing, and isolation space requirements for child day care centers, pursuant to Health and Safety Code Section 1596.806.

There is a board to post required postings, such as emergency disaster plan, notification of parent's rights, and car seat law (PUB269).

LPA toured the inside and outside of the facility. The Facility plans on utilizing the multipurpose room for 1st-5th and the art/music room for kindergarteners. The facility is not currently planning to offer care for TK. During todays inspection, the art/music room was not set-up as the teacher for the room will be prepping her room next week. The facility states they will have storage space in the art/music room for additional materials for children. The multipurpose room is equipped with a locked cabinet for Sprouts equipment as the room is used during the school day for various activities. The facility has art materials, legos, blocks, board games, and books. Disinfectant, cleaning supplies, and other items that are dangerous to children will be stored under the sink and made inaccessible. There are two (2) fully charged 3A40BC fire extinguishers, built in fire system, and carbon monoxide detector. Facility representatives state that there are no weapons or firearms stored on the premise. There are 8 tables and 45 chairs easily accessible to children and the room has additional tables/chairs that can be used as needed. There are approximately 60 hooks located outside for children to place their belongings.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SPROUTS SC HAPPY VALLEY
FACILITY NUMBER: 444417094
VISIT DATE: 08/01/2023
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
The facility will be using the boys and girls restroom on campus, which provides individual privacy and is separated for each gender. There are four toilets/ two sinks in the girls bathroom and three urinals/ two toilets/ two sinks in the boys bathroom. The children will be walked to the restroom as needed and in the art/music room there is a staff bathroom.

The facility will be using the field area and two playground on campus. Areas around the play structure and swings have resilient materials (tanbark) to absorb falls. LPA advised maintaining tanbark under the swings and slides when children are in care. There were no bodies of water observed during today's inspection. Shaded rest area is provided through building overhang and large trees. There are eight picnic benches available for use, basket ball court, school garden, and the facility will provide their own play equipment, such as balls, hula hoops, jump ropes, and frisbees. There is a drinking fountain located outside that children can use and they will also bring their water bottles outside.

The facility will be providing snacks for the children and there is menu posted. LPA advised adding portion sizes to the menu or a chart with serving sizes placed next to the menu. The school has a kitchen that can be used by the facility for preparing snacks that may need refrigeration or cooking. The Applicant states that they may place a mini fridge in the multipurpose room to store foods that may need refrigerating. Drinking water is provided through water fountains, water dispensers, and individual water bottles.

The facility does not plan on transporting children.

LPA 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.

The 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: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SPROUTS SC HAPPY VALLEY
FACILITY NUMBER: 444417094
VISIT DATE: 08/01/2023
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
Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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

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 email communication.

Exit interview conducted and report was reviewed with the facility representatives, Jordan Bemel and Shannon Blake.

LPA advised facility representatives upon review and approval by Licensing Management, a license for a school-age center will be granted and issued to Applicant.

LPA requested facility representatives submit photos of multi-purpose room and art/music room set-up prior to school starting on August 10th.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Cortney Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3