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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434417009
Report Date: 11/19/2021
Date Signed: 11/24/2021 01:34:30 PM

Document Has Been Signed on 11/24/2021 01:34 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:NOAH'S ARK CHILDREN LEARNING CENTERFACILITY NUMBER:
434417009
ADMINISTRATOR:CHIAYI LIFACILITY TYPE:
850
ADDRESS:560 HARRISON AVENUETELEPHONE:
(408) 691-3808
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 9DATE:
11/19/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:ChiaYi LiTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Dung Mac conducted an announced follow up Pre-licensing inspection to the facility today. LPA met with ChiaYi Li, Applicant Representative, and Amie Oman, Site Director, and explained the nature of today's inspection.

The initial pre-licensing inspection was completed on November 5, 2021. The Facility is applying for a license for 21 preschool children in Rooms 1 & 2. LPA inspected indoor and playground areas with the Applicant Representative. LPA notes that the following items have completed during today’s follow-up inspection.
1) The entry gate accessing to the front playground has a latch.
2) The bottom gap of the front gate was measured two inches and the gap of the steel
fence facing the street in the front preschool playground was closed.
3) The five-inch gap between the chain link fence and the steel fence in the front
preschool playground was measured three inches.
4) Waiver request and playground schedules for the Toddler Program to share
the Preschool Yard was submitted.
5) Updated indoor sketch was submitted.

LPA conducted an exit Interview and advised ChiaYi that a license for 21 Preschool children will be submitted for the final stage of review by Licensing Management.
SUPERVISORS NAME: Sandy Knight
LICENSING EVALUATOR NAME: Dung Mac
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2021
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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