434417101-9-7-2023-07-CC-MSMS-CVFQAD-20230907115946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417101
Report Date: 09/07/2023
Date Signed: 09/07/2023 11:59:50 AM

Document Has Been Signed on 09/07/2023 11:59 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:	BELLGRAD STEAM ACADEMY - RIVER GLEN		FACILITY NUMBER:	434417101
ADMINISTRATOR:	LARA TIRONA		FACILITY TYPE:	840
ADDRESS:	1088 BROADWAY AVE, RM.10,13&14		TELEPHONE:	(408) 568-3674
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95125
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	09/07/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Arulkumar "Arul" Sundarraman & Shakiba Khoshbin		TIME COMPLETED:	12:15 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	Licensing Program Analysts (LPAs), Mel Matos & Jessica Bongardt, conducted an announced prelicensing inspection to the Facility today in response to an application received by the Department for a school age license for children 4.9 to 15 years of age. LPAs met with Arulkumar Sundarraman, Applicant representative & Shakiba Khoshbin, director, and explained the nature of today's inspection to them. The Facility is located on the campus of River Glen School in Rooms 10, 13, & 14. Hours of operation will be: 7 AM to 9 AM & 2 PM to 6 PM during the calendar year for the San Jose Unified School District and 7 AM to 6 PM during school breaks. The program will be operating at a functioning elementary school site (River Glen School) and thus is exempt from the indoor and outdoor square footage requirements, fencing requirements, toilet/sink ratios, and isolation area requirements. No measurements were taken of the indoor and outdoor spaces during today's inspection. A capacity letter signed by the Principal of River Glen School is on file for Rooms 10, 13, & 14. Per the capacity letter, Rooms 10, 13, & 14 can accommodate 30 students each; total available capacity: 90. A fire clearance approval from the San Jose Fire Department was approved on July 13, 2023. LPAs reminded Arul and that all required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus, and Activity Schedule must be posted in all three classrooms. There are sufficient tables and chairs for the children in Rooms 10, 13, & 14. There is sufficient equipment and supplies for the school age children in all three rooms. However, the Facility does not have hooks/cubbie space for children to store personal belongings. LPAs observed solid waste containers with tight-fitting lids in each classroom. Staff and children's bathrooms are clean, sanitary, and operable. Boys and girls bathrooms are located near Room 13 and allow for individual privacy. The Facility has exclusive use of the boys and girls bathrooms. Staff have a designated bathroom on campus.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: BELLGRAD STEAM ACADEMY - RIVER GLEN	FACILITY NUMBER: 434417101
	VISIT DATE: 09/07/2023

NARRATIVE

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LPAs did not observe any fireplaces or wall heaters at the Facility. All three classrooms have appropriate lighting and ventilation (central heating/air conditioning). First aid supplies are stored in Room 13 and are inaccessible to children. The Facility will only provide snacks for the school age children. Disposables plates and utensils will be used to serve snacks to the children. Drinking water is provided via a combination of water fountains and refillable water bottles both indoors/outdoors. Cleaning supplies are located in locked cabinets. There are no poisons in the classrooms.

School age children will use the playground and field area on the River Glen School campus. LPAs observed that the playground is surrounded by appropriate fencing. There is sufficient materials and supplies for the children outdoors. Play structure is secure, age appropriate (5-12 years), and has artificial grass/padding as resilient materials. Shade is provided by trees and building overhang areas. Transportation will be not provided by the Facility. No bodies of water were observed during today's inspection. There is a working telephone at the site. The phone number is 408-568-3674.

LPAs conducted an exit interview with Arul and Shakiba prior to the conclusion of today's inspection and advised them that a license for 90 school age children will be approved upon completion of the following:

1) 90 hooks or cubbies have been purchased/installed.
2) Follow up inspection has been completed to verify completion of corrections.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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