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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010210219
Report Date: 05/20/2021
Date Signed: 05/20/2021 01:30:41 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:
(949) 378-7167
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:40CENSUS: 13DATE:
05/20/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Anna BencuyaTIME COMPLETED:
01:40 PM
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On 05/20/21 at 12:15pm, Licensing Program Manager (LPM) Mayla Mendoza and Licensing Program Analyst (LPA) Melissa Guirit arrived at the facility for an announced case management inspection. LPM and LPA met with the director, Anna Bencuya. The normal hours of operation are Monday-Friday 8:30 am-5:30 pm. An application was received to add an additional room, which is the social hall. There are no changes to the bathrooms and outdoor space that were previously licensed. LPM and LPA toured the facility including the additional room to be added to conduct a health and safety inspection, and completed the following measurements:

INDOORS: 2035.335 square feet = 58 children
OUTDOORS: 3512.50 square feet = 46 children

All other indoor and outdoor measurements remain the same. A fire clearance was received from the Oakland Fire Department on 04/14/21. An outdoor waiver will be requested for no more than 46 children at any given time.
LPM and LPA observed that there is sufficient heating, lighting and ventilation in the classrooms, and the classroom floors and surfaces are clean and free of hazards. The rooms have an ample supply of age appropriate furniture, toys and equipment which appear to be in good condition. LPM and LPA did not observe any bodies of water, hazardous items or toxins that would be accessible to children. LPM and LPA observed operating sinks and covered waste cans. The rooms are equipped with fully charged 3A40BC fire extinguishers, carbon monoxide detectors and centralized smoke detection systems. The facility has a working telephone and first aid supplies.

The social hall will be made part of the license, effective today 05/20/21, and can be used when the facility is ready. There are no deficiencies being cited today. This report will remain on file for 3 years. A Notice of Site inspection was provided to the director, and an exit interview was conducted.
SUPERVISOR'S NAME: Loretta DysonTELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Melissa GuiritTELEPHONE: (510) 566-8898
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2021
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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