434417099-7-18-2023-07-CC-YHUG-CTUTML-20230718145121

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417099
Report Date: 07/18/2023
Date Signed: 07/18/2023 02:51:32 PM

Document Has Been Signed on 07/18/2023 02:51 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
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	TLC OF CUPERTINO		FACILITY NUMBER:	434417099
ADMINISTRATOR:	LILI ZHU		FACILITY TYPE:	850
ADDRESS:	10038 BRET AVENUE		TELEPHONE:	(408) 624-2075
CITY:	CUPERTINO	STATE: CA	ZIP CODE:	95014
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/18/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Lili Zhu		TIME COMPLETED:	03:05 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Page 1 - Licensing Program Analysts (LPA) Oscar Huang conducted an announced pre-licensing inspection. LPA met with Applicant representative, Lili Zhu and explained the reason for the inspection. The purpose of this inspection is Applicant is applying for a preschool license for a capacity of 48 preschool children. The preschool center is located on 10038 Bret Avenue, Cupertino, CA 95014 in Room 1, 2, 3, and 4. LPA noted that Applicant is currently licensed a preschool center, Sunflower Learning Center, # 434412699 at 18900 Stevens Creek Blvd, Cupertino, CA 95014. There are areas in the hallway to post required postings, such as notification of parent's rights, personal rights, daily activity schedule, sketch, car seat, and menu. There hours of operation are Monday through Friday 8:30AM to 6:30PM. The contact phone at the site is (408) 621-2075. LPAs toured the inside and outside of the facility. Measurements were conducted during today's inspection. The indoor measurements for the preschool program is as followed: Room 1: (25.917 x 16.25) minus encumbered 20.435 = 400.716 Room 2: (25.917 x 17.833) minus encumbered space 13.995 = 448.182 Room 3: (25.917 x 16.583) minus encumbered space 20.435 = 409.346 Room 4: (16.75 x 27.417) minus encumbered space 20.435 = 438.799 Total space: (400.716 + 448.182 + 409.346 + 438.799) divided by 35 = 48 children

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TLC OF CUPERTINO	FACILITY NUMBER: 434417099
	VISIT DATE: 07/18/2023

NARRATIVE

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The outdoor space is as followed:
(76.25 x 51.167) + (7 x 37.167) = 4161.652
Total outdoor space 4161.652 divided by 75 = 55 children.

There are 48 chairs, 5 tables, 48 cubbies, 48 cots, 4 toilets, and 4 sinks for the preschool program in place. Staff have a separate bathroom which is located directly next to the children rest room, and for sick children to use if needed. Sick children will be isolated in the office and the isolation equipment will be provided. Staff and children's bathrooms are clean, sanitary, and operable. There are toys and equipment for children, which are age-appropriate. LPA reminded that all disinfectant, cleaning supplies, or other items that could pose a risk to children need to be inaccessible. LPA also discussed that minimum temperature in the room, which is 68 degrees Fahrenheit. There are 2 fully charged fire extinguishers in the facility, a smoke detector, and a carbon monoxide detector in each of 4 classrooms. There is a first aid kit stored in the office, which has all the required items.

The outdoor space is fenced. There is a play structure anchored in the playground. Area around play structure have resilient material, and under the play structure are cushioned with material that absorbs falls. There are toys and equipment for children. Shaded rest area is provided through pergolas, trees, and building overhangs. Applicant representative Lili stated that the drinking water during outdoor play time will be provided via children's own water bottles place on the rolling cart.

The facility does not provide meals but morning and afternoon snacks which are prepared in kitchen. Disposable utensils and plates will be utilized by the Facility. There is area to keep food warm and store any perishable food plates and drink cups. Drinking water is provided through water jug/dispenser in each of the classrooms to fill child's own water bottle. LPA discussed with trash can for waste need to have a tight fitted lid, and observed all the trash cans for waste have tight fitted lids.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TLC OF CUPERTINO	FACILITY NUMBER: 434417099
	VISIT DATE: 07/18/2023

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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

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

The Applicant representative and Director are associated to facility roster. Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

Applicant representative was 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.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TLC OF CUPERTINO	FACILITY NUMBER: 434417099
	VISIT DATE: 07/18/2023

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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 platform.

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.

Fire Clearance inspected by the Santa Clara County Fire Prevention Department was granted for the facility on 6/28/2023, and received by the office on 06/30/2023 :
Rooms approved are #1,2,3,4,lobby,kid restroom, outdoor play area for the children.
Rooms approved for staff usage are staff restroom, kitchen, office.
Fire Clearance Granted.

Exit interview conducted and report was reviewed with Applicant representative, Lili Zhu.

LPA advised Applicant representative upon approval of Licensing Management, a license for a preschool center for 48 children will be granted and issued to Applicant.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Yangcheng Huang
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC809 (FAS) - (06/04)

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