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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384001312
Report Date: 04/13/2022
Date Signed: 04/13/2022 12:48:57 PM


Document Has Been Signed on 04/13/2022 12:48 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



FACILITY NAME:SHALOM SCHOOLFACILITY NUMBER:
384001312
ADMINISTRATOR:HINDA LINGARFACILITY TYPE:
850
ADDRESS:862 28TH AVENUETELEPHONE:
(415) 831-8399
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94121
CAPACITY:36CENSUS: 27DATE:
04/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Ella Kasminskaya & Violetta LevinaTIME COMPLETED:
01:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mok conducted an unannounced annual inspection. LPA met with the Site Directors, Ella Kasminskaya, and Violetta Levina. The purpose of the inspection was explained to them. There were 27 children that included 9 toddlers with 7 staff presents. The facility was a combination center with Preschool and Toddler programs. The operation hours were Monday to Friday from 8:30AM to 5:15PM. The preschool program were run in 2 separated classrooms (Mitzvah Mavens - 4 yrs to 5 yrs old, & Torah Tots - from 3 yrs old and up) on the upper level, and the toddler program (18 months to 36 months) was run in a classroom on the ground level. The indoor areas were inspected today for health and safety hazards. No apparent hazards were observed. There were boy's and girl's bathrooms on the ground floor. There was a bathroom in the toddler room on the ground floor with 1 toilet and 1 sink. The girl's bathroom has two toilets and two sinks, the boy's bathroom has 2 urinals, 1 toilet and 2 sinks. There was no hot water all children's sinks. Separated staff bathroom is available for staffs in the office downstairs. Sick children will isolated in the director's office. The outdoor area on site and was observed to be in good condition. There were plenty of age-appropriate toys, books, learning material, and children's furniture available for children. Those items were in good condition and repair. Drinking water was served in pitcher with cups. The children also brought their own water cups to school if they like. All electrical outlets were covered. The children's bathrooms were clean and in order. All lower sink cabinet were either latched or free of harmful objects. Cots were available for napping. The children's beddings were stored in the separate bags with the children's names. The parents took the bedding home for washing every Friday, The facility provided AM/PM snacks and lunch to the children daily. The food preparation area was inspected during the inspection. The outdoor play areas were completely fenced. There were plenty of age-approrpriate outdoor toys, ride-on toys, slides, and play houses available for the children. The facility installed the soft cushioning to the entire ground to prevent injury. The facility also installed a gate at the stairway to prevent children access to the office limit area. The facility has conducted the fire drill monthly and logged. All required forms were posted (ie License, menus, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan). All children signed in today. Children's roster and Personnel Report were updated.

This report and notice of site visit were discussed with the licensee and must be made available to the public upon request. For quarterly update on Licensing information, go to CCL website: www.ccld.ca.gov. For Provider Information Notice: ccld.ca.gov/PG5098.htm.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Cindy MokTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2022
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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