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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010209547
Report Date: 08/24/2021
Date Signed: 08/24/2021 04:26:44 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:BETH SHOLOM PRESCHOOLFACILITY NUMBER:
010209547
ADMINISTRATOR:DANEK, SUSAN LFACILITY TYPE:
850
ADDRESS:642 DOLORES AVENUETELEPHONE:
(510) 357-8505
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:49CENSUS: 41DATE:
08/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Amanda ScottTIME COMPLETED:
04:44 PM
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(1) Licensing Program Analyst (LPA) Melanie Otsuji conducted the UNANNOUNCED REQUIRED 1 YEAR and ROOM ADDITION INSPECTION on today's date, 8/24/2021. LPA was met by Director, Amanda Scott. The center has submitted an application for a ROOM ADDITION OF 2 CLASSROOMS (YAROK, AND SEGOL" AND A NEW BATHROOM. Facility is also removing a classroom which was previously shown as "SMALL ROOM." A health and safety inspection was conducted inside and outside. Present during today's visit were 9 staff members and 41 preschool aged children. Facility days and hours of operation are Monday through Friday 7:30AM - 5:30PM. The facility measurements are as follows:

INDOORS: 3881.43 SQUARE FEET = 111 CHILDREN
OUTDOORS: 6842.38 SQUARE FEET = 91 CHILDREN

The center has obtained an approved fire clearance from Alameda County Fire Department for 49 children. Beth Sholom Preschool will have 4 approved classrooms (AUDITORIUM, ADOM, YAROK AND SEGOL). Facility will also have 2 play yards available for preschoolers. The preschool rooms are equipped with varied age appropriate materials and equipment. There are 7 toilets, and 6 sinks available for children use. The staff have a separate bathroom in which will also serve as an isolation bathroom. Individual Medical Services (IMS) policy was discussed. 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.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: BETH SHOLOM PRESCHOOL
FACILITY NUMBER: 010209547
VISIT DATE: 08/24/2021
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All licensing required documents are posted. Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted. The center was found to be clean, safe, sanitary and in good repair. There were no deficiencies cited during this visit.

A license for 49 preschool aged children operating out of Rooms Adom, Yarok, Segol and Auditorium will be issued today, effective 8/24/2021.

An exit interview was conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie OtsujiTELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
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