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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415223
Report Date: 12/20/2023
Date Signed: 12/20/2023 02:15:01 PM

Document Has Been Signed on 12/20/2023 02:15 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 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: 4CENSUS: 0DATE:
12/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Nora LacayoTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Mel Matos met with Nora Lacayo, director, for an unannounced case management inspection. Purpose of today's inspection: inspect the new play structure the Facility had installed in the preschool playground, which is located behind Rooms D101 (D1) and D102 (D2).

No day care children were present since the hours of operation are from 8:30 AM to 11:30 AM - Monday to Friday during the calendar school year for the Sunnyvale School District.

LPA toured the preschool playground with Nora during today's inspection. The new play structure is age appropriate (2-5 years of age per placards installed on the play structure) for the preschool children. The play structure is safe, secure, and has artificial grass with rubber padding as resilient materials surrounding and underneath the play structure. Shade is provided by the umbrellas, trees, and building overhang. LPAs did not observe any bodies of water during today's inspection.

LPA concludes that the Facility can start using the play structure for the preschool program effective immediately.

Exit interview conducted and report was reviewed with Nora Lacayo, director, and advised her that no deficiencies issued during today's inspection. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2023
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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