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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434400032
Report Date: 01/31/2023
Date Signed: 01/31/2023 03:51:01 PM

Document Has Been Signed on 01/31/2023 03:51 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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CALIFORNIA YOUNG WORLD AT SAN MIGUELFACILITY NUMBER:
434400032
ADMINISTRATOR:EMERSON VENTURAFACILITY TYPE:
840
ADDRESS:777 SAN MIGUEL AVENUETELEPHONE:
(408) 738-1385
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 28TOTAL ENROLLED CHILDREN: 26CENSUS: 17DATE:
01/31/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Emerson VenturaTIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs), Mel Matos and Cortney Nelson, met with Emerson Ventura, Director, for an announced case management inspection to the Facility today in response to a request submitted by the Facility to increase the licensed capacity to 42 school age children and add Room P4 to the existing school age license. The Facility is currently licensed in Portable 1 (P1). The school age program is in operation from 6:30 AM 8 AM and 12:30 PM to 6 PM Monday to Friday during the calendar school year and 6:30 AM to 6 PM Monday to Friday during school breaks.

The school age program is located on the campus of San Miguel Elementary School (functioning elementary school) and is thus exempt from indoor and outdoor square footage requirements, sink/toilet ratios, isolation space, and fencing requirements. Capacity letters ((28 for Portable 1 (P1) and (34 for Room P4) from the Sunnyvale School District are on file.

LPAs toured Portable 1 (P1) and Room P4 during today's inspection. Per the capacity letter for Room P4, the Facility will share room P4 with the school district. The Facility will have exclusive use of Room P4 from 2:15 PM to 6 PM Monday to Friday during the calendar school year and from 6:30 AM to 6 PM Monday to Friday during school recess periods. LPAs observed sufficient chairs, tables, and cubbies in Portable 1 (P1) and Room P4 during today's inspection. LPAs also observed adequate equipment, furniture, and supplies for children in all rooms.

The Facility only provides snacks for the school age children during the calendar school year. The Facility does provide breakfast, snacks, and lunch to the school age children during school breaks. There is a food preparation area in Portable 1 (P1) with a refrigerator, sink with hot/cold running water, toaster, warming oven, and microwave. Disposables dishes and utensils are used to serve snacks/meals to the school age children. The Facility has trash cans with tight fitting lids in both rooms.

The Facility currently has a playground area adjacent to Portable 1. However, the Facility will also utilize the school playground area adjacent to Room P4 and will have exclusive use to that playground area when Room P4 is in use. LPAs observed an age appropriate climbing structure with sufficient resilient materials in both playground areas. Shade is provided by a large sun sail and building overhangs. Drinking water will be provided via a combination of reusable water cups and water pitchers indoors and outdoors. There is adequate equipment and supplies for children outdoors. LPAs did not observe any bodies of water during today's inspection. Transportation is not provided by the Facility.

A fire clearance approval was received from the Sunnyvale Department of Public Safety prior to today's inspection. Exit interview was conducted with Emerson Ventura, director, and Emerson was advised that a license for 42 school age children in the following rooms: Portable 1 (P1) and Room P4 will be approved upon receipt of an updated Personnel Report (LIC 500) reflecting that the Facility has sufficient staff to maintain the required staff-children ratio for rooms Portable 1 (P1) and Room P4.

Notice of site visit issued and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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