434417101-9-13-2023-07-CC-MSMS-CVMUT7-20230913155129

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417101
Report Date: 09/13/2023
Date Signed: 09/13/2023 03:51:34 PM

Document Has Been Signed on 09/13/2023 03:51 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
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:	09/13/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Arulkumar "Arul" Sundarraman & Shakiba Khoshbin		TIME COMPLETED:	04:00 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 Analyst (LPA), Mel Matos, conducted an announced follow up prelicensing inspection to the Facility today. LPA met with Arulkumar "Arul" Sundarraman, Applicant representative, & Shakiba Khoshbin, director, and explained the nature of today's inspection to them. Initial prelicensing inspection was completed on September 7, 2023 and the Facility was advised that it needed 90 cubbies or hooks purchased and installed prior to approval of a school age license for 90 children. Purpose of cubbies or hooks: individual space for the children to store personal belongings. LPA toured Rooms 10, 13, & 14 and observed that the Facility purchased a rolling storage cart for each room (3 total) that has 30 hooks per cart. The following items were also discussed prior to the conclusion of today's inspection. Arul 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. 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 Review of records to be maintained - Child Care Centers LPA reviewed with [applicant, licensee, or 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.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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: 09/13/2023

NARRATIVE

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Arul 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.

Child Care Centers and Family Child Care Homes: 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 athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with Arulkumar "Arul" Sundarraman, Applicant representative & Shakiba Khoshbin, director. LPA advised them that the Facility has met all the requirements and thus a license for 90 school age children will be approved effective today, September 13, 2023.

SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Melvin S Matos
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC809 (FAS) - (06/04)

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