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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430710561
Report Date: 08/15/2023
Date Signed: 08/15/2023 10:33:15 AM

Document Has Been Signed on 08/15/2023 10:33 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:CALIFORNIA YOUNG WORLD AT ELLISFACILITY NUMBER:
430710561
ADMINISTRATOR:NORA LACAYOFACILITY TYPE:
840
ADDRESS:550 EAST OLIVE STREETTELEPHONE:
(408) 774-0405
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 0DATE:
08/15/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nora LacayoTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs), Mel Matos & Jessica Bongardt, conducted an follow up announced case management inspection to the Facility today in response to a request received by the Department to drop Room P-9 and P-10 from the existing license and adding Rooms D101 (D1) and D102 (D2) to the preschool license. LPAs met with Nora Lacayo, director, and explained the nature of today's inspection to her. The Facility is located on the campus of Ellis Elementary School. The licensed capacity remains unchanged (56 school age children). Hours of operation: 6:30 AM to 8 AM - Monday to Friday, 2 PM to 6 PM - Monday to Thursday, and 12:45 AM to 6 PM - Friday.

The program is operating at a functioning elementary school site (Ellis Elementary School) and thus is exempt from the indoor and outdoor square footage requirements, fencing requirements, toilet/sink ratios, and isolation area requirements. No measurements were taken of the indoor and outdoor spaces during today's inspection. A capacity letter signed by the Director of Facilities & Operations for the Sunnyvale School District is on file for Rooms D101 (D1) and D102 (D2). Per the capacity letter, Rooms D101 (D1) and D102 (D2) can accommodate 34 students each; total available capacity: 68. A fire clearance approval from Sunnyvale Department of Public Safety has not been received as of today's inspection.

School age children will use the playground area, located behind Rooms D101 (D1) & D102 (D2). LPAs observed that the playground is surrounded by appropriate fencing. There is sufficient materials and supplies for the children outdoors. Shade is provided by the umbrellas, trees, and building overhang. LPAs did not observe any bodies of water during today's inspection. Transportation will not be provided by the Facility.

LPAs conducted an exit interview with Nora prior to the conclusion of today's inspection and advised her that a license for 56 school age children in Rooms D101 (D1) and D102 (D2) will be approved upon receipt of an approved fire clearance from the Sunnyvale Department of Public Safety.
Notice of site was issued and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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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