384000303-1-10-2024-05-CC-CQUO-CZCRL4-20240110120630

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 384000303
Report Date: 01/10/2024
Date Signed: 01/10/2024 12:06:34 PM

Document Has Been Signed on 01/10/2024 12:06 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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	JEWISH FAMILY PRESCHOOL-CONGREGATION BETH SHOLOM		FACILITY NUMBER:	384000303
ADMINISTRATOR:	DALE KLEISLEY		FACILITY TYPE:	850
ADDRESS:	301 14TH AVENUE		TELEPHONE:	(415) 221-8736
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94118
CAPACITY:	76	CENSUS: 32	DATE:	01/10/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Dale Kleisley		TIME COMPLETED:	12:20 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 January 10, 2024 at approximately 8:30am, Licensing Program Analyst (LPA) Catrina Quimbo conducted a case management visit to Jewish Family Preschool. LPA met with director, Dale Kleisley, and explained the purpose of the inspection. Present during visit included 32 children with 10 teaching staff. Program is a preschool license that is licensed to operate in Rooms #1 - #4, #124, and #125. In July 2023, director requested to add a toddler option component to facility. Director also informed department Rooms #1 - #4 will undergo construction from approximately July 2024 through August 2025. Director also requested the temporary use of 2 additional classrooms during construction period. Fire clearance for rooms to be added has not yet been received. Director requested use of Toddler room for toddler option children, and Room #113 (board room) and Room #126 (library) as the temporary spaces to use during construction. Director was reminded children in preschool program and toddler option cannot co-mingle and must be kept physically separate. LPA measured rooms to be added and inspected rooms for health and safety hazards. Toddler Room was measured for 367.76 sq. ft. allowing for a capacity of 10 children. Toddler room includes an exclusive bathroom with 1 toilet and 1 sink. LPA observed toddler room to have a variety of toys, materials and equipment that were observed to be in good condition. There is an outdoor area that is located directly next to the toddler room. Toddler outdoor area (next to toddler room) was measured for 310.16 sq. ft. allowing for a capacity of 4 children. Outdoor area includes a sandbox and chicken coop. Chicken coop was observed to be gated. Sand box was observed to have a sand box cover. Entire outdoor area is fully fenced and enclosed. Room #126 (library) is one room that includes a lower level indent. Per director, only lower level may be used as a temporary classroom space or entire library. LPA measured room in two portions (indent alone and entire room). Room #126 indent only was measured for 268.93 sq. ft. allowing for a capacity of 7 children. Entire Room #126 was measured for 1,071.70 sq. ft. allowing for a capacity of 30 children. (Continue Report on Page 2...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JEWISH FAMILY PRESCHOOL-CONGREGATION BETH SHOLOM	FACILITY NUMBER: 384000303
	VISIT DATE: 01/10/2024

NARRATIVE

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There is an enclosed outdoor area/courtyard located next to library that children will also have access to. Outdoor area (next to library) was measured for 1,230.03 sq. ft. allowing for a capacity of 16 children. Director was reminded children must be supervised going to and from the outdoor area.

Room #113 (board room) was measured for 481.79 sq. ft. allowing for a capacity of 13 children. Director plans to set up rooms that will include children's toys, materials and furniture.

While Rooms #1 - #4 are under construction, director plans for program to operate in Room #124 (licensed), Room #125 (licensed), Room #126 (library inspected on today's date), and Room #113 (board room inspected on today's date). While facility is under construction, director plans for Room #124 to be used as the temporary toddler option room while Room #125, Room #126, Room #113 will be for the preschool program.

There are adult restrooms that children will have access to during construction period. LPA reminded director stalls that will be utilized for children must be labeled. LPA also reminded director children cannot use restroom while an adult uses restroom. Director was also reminded children must be supervised going to and from restroom.

LPA observed entire facility to include fire sprinklers, smoke detectors and fire alarm system. Per director, detectors throughout building are dual smoke/carbon monoxide detectors. LPA reminded director to keep department informed of when construction to facility begins. LPA also reminded director once construction to Rooms #1-4 have been completed, a follow up case management visit must be conducted by an LPA and a follow up fire inspection must be conducted.

Director stated they are aware Rooms #124, #125, #126, #113 must be fully set up and cleared of storage prior to children's use. Photos will be sent to LPA at a later date.

During LPA's visit on this date, director also requested to include additional rooms in facility as possible classroom spaces to use during construction period. Director was reminded LPA cannot approve of additional rooms until fire department approves of additional rooms.
(Continue Report on Page 3...)

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JEWISH FAMILY PRESCHOOL-CONGREGATION BETH SHOLOM	FACILITY NUMBER: 384000303
	VISIT DATE: 01/10/2024

NARRATIVE

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(Continued, Page 3...)
Possible rooms to be added as a temporary space during construction include Room #114 (next to kitchen), and second level Rooms #20 - #25. LPA measured possible rooms to be added.

Room #114 was measured for 704.56 sq. ft. allowing for a capacity of 20 children. Room #20 was measured for 279.51 sq. ft. allowing for a capacity of 7 children. Room #21 was measured for 284.2 sq. ft. allowing for a capacity of 8 children. Room #22 was measured for 281.01 sq. ft. allowing for a capacity of 8 children. Room #23 was measured for 328.22 sq. ft. allowing for a capacity of 9 children. Room #24 and #25 (one large room) was measured for 645.83 sq. ft. allowing for a capacity of 18 children. During LPA's visit, rooms were not set up as preschool classrooms.

LPA advised director to discuss addition of possible rooms with fire department. LPA also reminded director LPA cannot increase capacity unless a capacity increase has been submitted to department.

During visit, LPA received from director an updated Child Care Center Application (LIC200A), updated Administrative Organization (LIC309), updated Personnel Report (LIC500), updated Parent Handbook and updated Financial Agreement. LPA advised director to submit updated facility sketches (LIC999) for all possible rooms that may be utilized during construction period.

Due to square footage, LPA will approve for a capacity of 10 children in Toddler Room for the toddler option children when fire clearance is received.

LPA will also approve of temporary Room #126, Room #113, Room #114, and Rooms #20-#25 when fire clearance is received.

A notice of site visit was given and must remain posted.

Exit interview conducted and report was reviewed with director, Dale Kleisley.

SUPERVISOR'S NAME: Marie Rodriguez	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Catrina Quimbo	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC809 (FAS) - (06/04)

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