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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416574
Report Date: 04/11/2024
Date Signed: 04/11/2024 11:34:54 AM

Document Has Been Signed on 04/11/2024 11:34 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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CUPERTINO CO-OP NURSERY SCHOOLFACILITY NUMBER:
434416574
ADMINISTRATOR/
DIRECTOR:		JENNIE IVAZIANFACILITY TYPE:
860
ADDRESS:1025 THE DALLES AVENUETELEPHONE:
(408) 739-8963
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
04/11/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Jennie IvazianTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 04/11/2024, Licensing Program Analysts (LPAs) Harsimran Kaur and Janette Cruz met with Applicant representatives, Jennie Ivazian, Applicant Representative. The purpose of the visit was an announced pre-licensing inspection at the facility to ensure the health, safety and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. Applicants requested for a change of location of a parent-cooperative preschool license with capacity of 24 children ages 2 to 6 years. The facility has an existing parent-cooperative preschool program Facility#430709820. The child care center will operate part-time programs from Monday–Friday 9AM to 11:30AM. During days from Monday-Thursday, afternoon program is available from 12:15PM to 3:30PM. Facility is located in a church site (St. Luke Lutheran Church). The fire clearance was approved on April 10, 2024. .

LPAs toured and measured the on-limits areas and classrooms located at the facility. The facility has a total of 2 classrooms.

Preschool Classroom measurements are:

The Indoor total measurements contain a total of {906.81} square feet, which will accommodate Applicant's request for 24 preschool children.

Preschool Outdoor Play measurements are:

Outdoor total measurements contain a total of {6542.20 square feet), which will accommodate Applicant’s request for 24 preschool children.

Indoor/Children's Area


There are two classrooms (main room & music room) assigned for preschool at the facility. The preschool classroom is observed to be clean, safe, sanitary and in good repair. All outdoor and indoor passage ways and other areas of potential hazard were free of obstruction. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children, including toys, shall be free of toxic substances. All play equipment and materials used by children were observed to be age-appropriate. Tables and chairs were observed to meet the needs of the children There are 27 chairs, 5 tables, 2 sinks, 25 cubbies, 2 toilets, available for preschool children.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024
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
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CUPERTINO CO-OP NURSERY SCHOOL
FACILITY NUMBER: 434416574
VISIT DATE: 04/11/2024
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The Applicant shall take measures to keep the center free of flies, other insects, and rodents. All containers used for storage of solid wastes, including moveable bins, shall have a tight fitting cover that is kept on. LPAs observed no fireplace or open face heaters. Snacks will be provided by parents. The facility has kitchen area with fridge and microwave. Kitchen is off-limits to children. Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children shall be stored where inaccessible to children. Drinking water is readily available for the children in the facility via filtered water pitchers and water bottles.

LPAs observed a fully equipped first aid kit located in the main room. There is an operational carbon monoxide detector on site. LPAs observed sign in/sign out sheets were in compliance. A separate staff bathroom is available. Applicant stated that any child who becomes ill during the day shall be isolated in the facility office.

LPAs advised Applicant as per child care regulation 101216.5 ,parent-cooperative centers shall employ a full-time teacher in addition to the director and participating parents when the number of children reaches 25. There shall be at least one staff member or participating parent present for each five children in attendance.


Outdoor:

LPAs observed outdoor area for preschool children were free of hazards including, holes, broken glass dry grasses, and other debris that pose a fire hazard. Shade was provided by trees. The playground is enclosed by a fencing at least 4 feet high. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is adequate cushioning in fall zones provided by tan barks and sand. LPAs observed no bodies of water. Any construction or equipment that could pose a hazard in the outdoor activity area shall be made inaccessible to children in care. LPAs observed a walk-in chicken coop accessible to children.


Drinking water from a non-contaminating fixture or container shall be readily available both indoors and in the outdoor activity area. LPAs advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CUPERTINO CO-OP NURSERY SCHOOL
FACILITY NUMBER: 434416574
VISIT DATE: 04/11/2024
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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.


LPAs discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as
an additional resource. LPAs also informed Applicants of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPAs reviewed with the Applicants LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicants were informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

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 platforms. 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.


An exit interview was conducted and copy of appeal rights were provided to Jennie Ivazian, Licensee Representative. Final license determination for a single license will be made upon review by the Licensing Program Manager.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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