434417108-8-10-2023-07-CC-PHEZ-CUKSMC-20230810135944

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434417108
Report Date: 08/10/2023
Date Signed: 08/10/2023 01:59:52 PM

Document Has Been Signed on 08/10/2023 01:59 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:	CUSD MEYERHOLZ CUPERDOODLE PRESCHOOL		FACILITY NUMBER:	434417108
ADMINISTRATOR:	MICHELLE HERRIAGE		FACILITY TYPE:	850
ADDRESS:	6990 MELVIN DRIVE		TELEPHONE:	(408) 252-3000
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95129
CAPACITY: 84	TOTAL ENROLLED CHILDREN: 84	CENSUS: 0	DATE:	08/10/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Michelle Herriage		TIME COMPLETED:	02:15 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 Analyst (LPA) Pete Hernandez conducted a scheduled Pre licensing Applicant Initiated inspection with the Applicant Director Michelle Harriage. LPA explained the purpose of the visit. The Facility is being relocated from CUSD Muir Elementary to the grounds of CUSD Meyerholz Cuperdoodle Elementry. The Preschool Center's Normal Business hours Monday - Friday 7:30 AM to 6:00 PM. The Applicant will use the same layout as the current license. The rooms are named 1. 2. 22. and 23. A Fire Clearance inspection was approved on 8/4/2023 from the San Jose Fire Department. The Fire extinguishers in the rooms were last serviced on 6/21/2023. LPA also observed that the facility has working carbon monoxide and smoke detectors, and first aid kits. Rooms 1, 2, 22, 23 and restrooms and the outdoor areas were inspected. Children at the Center will have access to the restrooms, sinks, water on the school campus. There are restrooms located Inside of the class rooms. The children will be using the playground area for outdoor activities. LPA observed that the facility has a supply of play equipment for outdoor activities and outdoor activity space is enclosed with fencing and has shaded areas. Restrooms for boys and girls are separated and provide individual privacy inside the room attached to the same building. Children will also be bringing their own water bottle and the Center has portable water dispenser to ensure that drinking water is available. Furniture and equipment for children to use were observed. There were tables and chairs for children to use. Weapons will not be stored on the premises and LPA did not observe any bodies of water on campus. The Center will not be providing transportation.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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: CUSD MEYERHOLZ CUPERDOODLE PRESCHOOL	FACILITY NUMBER: 434417108
	VISIT DATE: 08/10/2023

NARRATIVE

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The Center will provide healthy snacks. Children will occasionally bring their own snacks when attending. LPA observed container used for storage of solid wastes has tight-fitting cover on. Detergents, cleaning compounds, medicines, and other items which could pose a danger if readily available to children were stored where they are inaccessible to children in care. Storage cabinets have locks. At the end of the day, facility will receive janitorial service provided by the school.

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

This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) tollfree 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.

Applicant 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.

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 at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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: CUSD MEYERHOLZ CUPERDOODLE PRESCHOOL	FACILITY NUMBER: 434417108
	VISIT DATE: 08/10/2023

NARRATIVE

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FURNITURE LIST: 16 tables, adult desk, 96 chairs, 2 adult chairs, 96 sleeping mats, Shelves for manipulatives.

RESTROOMS: 10 sinks and 10 toilets.

INDOOR MEASUREMENTS ARE AS FOLLOWS:
Room 1: ( 30 X 44) = 1320 minus 62.916 (encumbered space) = 1257.084
Room 2 :( 30 X 44) = 1320 minus 59.166 (encumbered space) = 1260.834
Room 22: ( 30 X 39 ) = 1170 minus 66.001 (encumbered space) = 1103.999
Room 23: ( 30 X 39 ) = 1170 minus 75.207 (encumbered space) = 1094.793
TOTAL INDOOR SPACE: = 4716.710 divided by 35 = 134.763 preschool children.

OUTDOOR MEASUREMENTS ARE AS FOLLOWS:

Playground: 9400 total sq. ft. divided by 75 = 125.333 Children.

LPA reviewed with Michelle Harriage the LIC 311A, Records to Be Maintained at The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed the safe sleep regulations with Michelle Harriage and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed Michelle Harriage of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

LPA notes that the capacity approved and requested on application is 96 but the capacity on this report shows 84.

Licensee understands that the licensure will require prior management approval.

Exit interview conducted and report was reviewed with the Michelle Harriage.

SUPERVISORS NAME: Gladys Kuizon
LICENSING EVALUATOR NAME: Pietro Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC809 (FAS) - (06/04)

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