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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 444417155
Report Date: 11/05/2024
Date Signed: 11/05/2024 12:33:06 PM

Document Has Been Signed on 11/05/2024 12:33 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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LIGHTSPEED MARTIAL ARTSFACILITY NUMBER:
444417155
ADMINISTRATOR/
DIRECTOR:		MATTHEW SALISBURYFACILITY TYPE:
860
ADDRESS:1800 GREEN HILLS ROAD UNIT 111TELEPHONE:
(831) 438-6068
CITY:SCOTTS VALLEYSTATE: CAZIP CODE:
95066
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
11/05/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Matthew SalisburyTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 11/5/24 Licensing Program Analysts (LPAs) Harsimran Kaur and Janette Cruz met with Matthew Salisbury, Applicant representative. The purpose of the visit was an announced pre-licensing inspection at the facility to ensure the health, safety and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. Applicant is applying for 50 school age children ages 5 to 12 years. The child care center will operate Monday–Friday from 2:30pm - 6:00 PM. The facility is located in a commercial building (Greenhills Tech Center) unit number #111. The fire clearance was approved on 09/16/2024. There were no children present during today's inspection.

LPAs toured and measured the on-limits areas and classroom within the facility. The facility has one main classroom with separate areas used as Art, Play and Quiet room. .

School Age Classroom measurements are:

The Indoor total measurements contain a total of {2394.45} square feet, which will accommodate Applicant’s request for 50 school age children.

School age Outdoor Play measurements are:


Outdoor total measurements contain a total of {5235.84} square feet, which will accommodate Applicant’s request for 50 school age children.

LPAs observed all areas of the classroom to be clean, safe, sanitary and in good repair. A comfortable temperature for children shall be maintained at all times. Furniture and equipment were observed to be maintained in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children, including toys, shall be free of toxic substances. All play equipment and materials used by children were observed to be age-appropriate. LPAs observed no fireplace or open face heaters. LPAs observed a fully charged fire extinguisher in the facility. There are 10 chairs, 4 benches (capacity x 4), 4 tables, 6 sinks, 80 cubbies , 5 toilets, 1 urinal available for the children. Staff can use a separate common bathroom in the building that can be utilized by sick children if needed. Sick children will be isolated in the office area of the facility. LPAs observed that items that may pose a danger to children were stored in locked storage

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN JOSE CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LIGHTSPEED MARTIAL ARTS
FACILITY NUMBER: 444417155
VISIT DATE: 11/05/2024
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rooms inaccessible to children. LPAs advised that Applicant maintains the following first-aid supplies in a location accessible to staff but inaccessible to children: current edition of a first-aid manual, sterile first-aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometer, and antiseptic solution.

Applicant stated that facility shall reserve the women's and men's bathrooms in the building located at right side of unit 111 exclusively for school-age children during facility's operating hours. Applicant stated that the two bathrooms will be labeled as exclusively available to school age children from 2:30pm - 6pm. The bathrooms shall be checked by a qualified adult before use to ensure that only school age children are using the designated bathrooms. Applicant was advised that toilet facilities for school age program shall provide individual privacy and shall not be used simultaneously by children of both sexes.



The Applicant shall take measures to keep the center free of flies, other insects, and rodents. Snacks can be brought from home but will also be available at the facility. Drinking water is readily available for the children in the facility via water fountains and water dispensers/bottled waters.

Outdoor area for school age children (located at building's outdoor basketball court) shall be exclusively available for the children during facility operating hours from 2pm to 5pm as per lease agreement. LPA observed that outdoor play area free of hazards including, holes, broken glass dry grasses, and other debris that could pose a fire hazard. Shade was provided by trees. The playground is enclosed by a fence to protect children and to keep them in the outdoor activity area. LPAs observed no bodies of water. The fence is at least four feet high.



Drinking water from a non-contaminating fixture or container shall be readily available both indoors and in the outdoor activity area. LPAs advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test.

Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

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) 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.

SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
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 CC RO, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LIGHTSPEED MARTIAL ARTS
FACILITY NUMBER: 444417155
VISIT DATE: 11/05/2024
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LPAs discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep, as an additional resource. LPAs also informed Applicant 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.

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

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-care-licensing/subscribe and select the Child Care option to receive email communication.


The following corrections are needed before a licensure will be considered.
1. Proof of available carbon monoxide detector.
2. Proof of available containers with tight fitting lids for disposal of solid wastes.
3. Proof of control of property for use of women and men's bathrooms next to unit 111 exclusively for school-age children during facility operating hours.
4. Proof of complete first-aid supplies.

An exit interview was conducted and reviewed with Matthew Salisbury, Applicant. Final license determination will be made upon review by the Licensing Program Manager.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Harsimran Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024
LIC809 (FAS) - (06/04)
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