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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415223
Report Date: 08/09/2023
Date Signed: 08/09/2023 10:54:36 AM

Document Has Been Signed on 08/09/2023 10:54 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:
434415223
ADMINISTRATOR:NORA LACAYOFACILITY TYPE:
850
ADDRESS:550 EAST OLIVE AVENUETELEPHONE:
(408) 774-0405
CITY:SUNNYVALESTATE: CAZIP CODE:
94086
CAPACITY: 24TOTAL ENROLLED CHILDREN: 1CENSUS: 0DATE:
08/09/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Nora LacayoTIME COMPLETED:
09:50 AM
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Licensing Program Analyst (LPA), Mel Matos, conducted an announced case management inspection to the Facility today in response to a request received by the Department to drop Room P-10 from the existing license and adding Rooms D101 (D1) and D102 (D2) to the preschool license. LPA 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 (24 preschool children). Hours of operation: 8:30 AM to 11:30 AM - Monday to Friday during the calendar school year for the Sunnyvale School District. A fire clearance approval from Sunnyvale Department of Public Safety has not been received as of today's inspection. Measurements of the Indoor space were taken during today's inspection and are noted below. No outdoor measurements were taken during today's inspection since the outdoor space is still under construction.

Indoor measurements:

Room D101 (D1): 27.917 x 29.917 = 835.192
Room D102 (D2): (10 x 27 = 270) + (10.333 x 16.667 = 172.220) = 442.220

Total indoor space: 1,277.412 divided by 35 = 36 preschool children

LPA reminded Nora that all required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule must be posted in Rooms D101 (D1) & D102 (D2).

There are sufficient tables, chairs, and cubbies/hooks for the children in both Rooms. There is sufficient equipment and supplies for the school age children in both rooms. LPA observed solid waste containers with tight-fitting lids in both Rooms. Staff and children's bathrooms are clean, sanitary, and operable.

LPA notes that the kitchen/food prep area is located in Room D101 (D1). Drinking water will be provided via drinking fountains & water jugs cups/water bottles indoors and outdoors. The playground area is currently under construction and a follow up inspection will be required to measure and inspect the space.

LPA conducted an exit interview with Nora prior to the conclusion of today's inspection and advised her that a license for 24 preschool children in Rooms D101 (D1) and D102 (D2) will be approved upon receipt of an approved fire clearance and outdoor space approval. Notice of site visit was issued and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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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