010213705-10-13-2022-52-CC-MOTI-CK6U35-20221013151259

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 010213705
Report Date: 10/13/2022
Date Signed: 10/13/2022 03:13:05 PM

Document Has Been Signed on 10/13/2022 03:13 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	GAN SAMEACH NURSERY SCHOOL		FACILITY NUMBER:	010213705
ADMINISTRATOR:	JACOB, ANNIE		FACILITY TYPE:	850
ADDRESS:	42000 PASEO PADRE PARKWAY		TELEPHONE:	(510) 651-5833
CITY:	FREMONT	STATE: CA	ZIP CODE:	94539
CAPACITY:	22	CENSUS: 8	DATE:	10/13/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Annie Jacob		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/13/2022 Licensing Program Analyst (LPA) Melanie Otsuji conducted an UNANNOUNCED 1 YEAR REQUIRED INSPECTION. LPA met with Director, Annie Jacob. Also present during today's visit was 1 additional staff member and 8 preschool aged children. The facility was toured to conduct a Health and Safety Inspection. This program currently operates Monday - Friday 8AM - 6PM. Two classrooms were inspected for age appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the presence of working carbon monoxide detector, smoke detectors/fire alarms and fully charged fire extinguishers that is accessible throughout the facility. There are no pools, hot tubs or other accessible bodies of water. Cleaning supplies/toxins are stored inaccessible to children during the inspection and all required postings are present. The facility provides AM snack with children bringing lunch from home. Children bring their own water bottles from home and the facility refills them with a water dispenser. The center also conducts and documents fire and earthquake drills once every 6 months and the logs show that drills were conducted on August 5, 2022. A copy of the facility personnel roster and children’s roster were available for review and copy was obtained. LPA reviewed Director's file and Director has current CPR/First Aid certification. Staff interview also conducted and documented.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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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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: GAN SAMEACH NURSERY SCHOOL	FACILITY NUMBER: 010213705
	VISIT DATE: 10/13/2022

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA did not need to review medication during the inspection as the facility did not currently have any medication stored. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage athttps://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative 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.

No deficiencies found on today's date. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director, Annie Jacob.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2593
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 341-5559
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC809 (FAS) - (06/04)

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