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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434416983
Report Date: 08/20/2021
Date Signed: 08/31/2021 09:53:51 AM

Document Has Been Signed on 08/31/2021 09:53 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:GILROY HEAD STARTFACILITY NUMBER:
434416983
ADMINISTRATOR:RENEE GARCIA / EVA SUAREZFACILITY TYPE:
850
ADDRESS:9300 WREN AVENUETELEPHONE:
(669) 212-8692
CITY:GILROYSTATE: CAZIP CODE:
95020
CAPACITY: 43TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/20/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Eva SuarezTIME COMPLETED:
11:01 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Samantha Yip and Cortney Nelson conducted a pre-licensing inspection. LPAs met with Site Director Eva Suarez and Jim Browning, Facilities & Construction Coordinator, and explained the reason for the inspection. The purpose of this inspection is to conduct a follow-up to ensure that repairs were made to the outdoor activity area; the stairs in the play structure, holes in the resilient materials were filled, and sandbox was filled.

LPAs observed that the cube stairs that were rusting were changed to a ladder. LPAs observed that resilient material below the ladder is starting to give way. Site Director stated that they have a work order to have the resilient material to be repaired. She stated that it should be repaired by the end of the September. Site Director stated that she will follow-up with Licensing once it gets repaired. Site Director stated that they are going to close off the area by the ladder until resilient material is repaired. LPA also observed that the sandbox and the holes in the resilient materials were filled. LPAs also observed that resilient material where it meets the concrete was even out, so it does not become a tripping hazard. The age recommendation for the play structure is 2-5 years old. LPAs also observed that the top layer of stairs on the play structure is peeling. Site Director stated that they have a work order to repair the parts of the stairs that were peeling.

Site Director stated that she will follow up with Licensing on the following:
- repair of resilient material below the ladder
- power wash of the outside area
- repair of the stairs on the play structure

An exit interview was conducted where this report was discussed and provided to Site Director Eva Suarez. Site Director was informed that upon approval of Licensing Management, a license for a preschool child care center will be granted and issued upon final review of waiver request for the shared bathroom.
SUPERVISORS NAME: Anthony Studebaker
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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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