Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434414180
Report Date: 09/23/2016
Date Signed 09/23/2016 11:49:31 AM

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:GENIUS KIDS SANTA CLARAFACILITY NUMBER:
434414180
ADMINISTRATOR:SINDY PULIDOFACILITY TYPE:
850
ADDRESS:4953 STEVENS CREEK BLVD.TELEPHONE:
(408) 431-7003
CITY:SANTA CLARASTATE: CAZIP CODE:
95051
CAPACITY:15CENSUS: 14DATE:
09/23/2016
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sapna RastogiTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA), Mel Matos, conducted an unannounced case management visit to the Facility today. LPA met with Sapna Rastogi, Licensee representative, and explained the nature of today's visit to her. Sapna informed LPA that she is adding a bathroom, with one sink and toilet, to the Facility. Sapna states that she is planning on requesting an increase of her licensed capacity once the entire project is completed.

LPA observed the construction area, which is located adjacent to the existing staff and children's bathrooms during today's visit. The construction area is sectioned off and not accessible to the day care children. Sapna states that all construction work is conducted after hours and on the weekends. Sapna has obtained the required construction permit from the City of Santa Clara for the project and she anticipates that the entire project will be done by October 4, 2016.

LPA advised Sapna to submit an updated Application for a Child Care Center License (LIC 200A), $25.00 payment, updated Facility sketch, and a copy of the final inspection sign off from the city of Santa Clara to the Department once the new bathroom is completed to initiate the increase of capacity request.

LPA advised Sapna that a new fire clearance from the Santa Clara Fire Department will be required as well as a follow up visit from LPA.

No deficiencies issued during today's visit.


A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Melvin S MatosTELEPHONE: (408) 334-8554
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2016
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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