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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010210219
Report Date: 02/28/2020
Date Signed: 02/28/2020 12:52:07 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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GAN MAH TOV PRESCHOOLFACILITY NUMBER:
010210219
ADMINISTRATOR:BENCUYA, ANNAFACILITY TYPE:
850
ADDRESS:3778 PARK BOULEVARDTELEPHONE:
(510) 530-2146
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:40CENSUS: 28DATE:
02/28/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Anna Bencuya & Jennifer Salvago-KeyesTIME COMPLETED:
01:10 PM
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A Case Management Visit was conducted on this date 2/28/20 by Licensing Program Analyst (LPA), Mayla Mendoza. LPA met with Assistant Director, Jennifer Salvago-Keyes and later Director Anna Bencuya. The center has applied to add the Social Hall as a gross motor room in addition to the play yards, with no increase in the number of children they are currently licensed for. A health and safety inspection was conducted inside and outside. The preschool center is currently licensed in 2 rooms (Gan Gozalim & Gan Tzipporim). Hours of operation are from 8:30am-5:30pm, Monday through Thursday, 8:30pm-4:00pm on Fridays. Measurements are as follows:

INDOORS: 1399.5 square feet = 40 children
OUTDOORS: 4546.819 square feet = 60 children

First aid supplies are available in the center. Facility has a functioning carbon monoxide detector. Sign in and out logs were reviewed. Play yard has sufficient cushioning by way of sand. There are 6 sinks and 3 toilets available to the preschool children. Preschool also has an infant program on site. Snacks are being served. Menus are posted. Required documents are posted.

This facility plans to provide Individual Medical Services – IMS. 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)/ (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.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: GAN MAH TOV PRESCHOOL
FACILITY NUMBER: 010210219
VISIT DATE: 02/28/2020
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A review of staff records on 2/28/20 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The center has obtained an approved fire clearance from the Oakland Fire Department.

Mandated reporter and appeal rights, civil penalties, unusual incident reporting and fingerprint requirements were discussed today. Licensee is also being informed of the web address (www.ccld.ca.gov) for downloading child care forms, and the director is encouraged to email ChildCareAdvocatesprogram@dss.ca.gov to be included in the Child Care Quarterly Updates distribution list. The director is also reminded that mandated reporter training is required for all staff and is to be renewed every 2 years at www.mandatedreporterca.com.

There were no deficiencies cited during this visit. Social Hall can now be used as a gross motor room, in addition to their play yard, effective today 2/28/20.

An exit interview was conducted.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Mayla MendozaTELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2020
LIC809 (FAS) - (06/04)
Page: 2 of 2