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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509197
Report Date: 09/26/2019
Date Signed: 09/26/2019 12:54:30 PM

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:PENINSULA TEMPLE SHOLOM PRESCHOOLFACILITY NUMBER:
410509197
ADMINISTRATOR:STECKLEY, ALLISONFACILITY TYPE:
850
ADDRESS:1655 SEBASTIAN DRIVETELEPHONE:
(650) 697-2279
CITY:BURLINGAMESTATE: CAZIP CODE:
94010
CAPACITY:148CENSUS: 126DATE:
09/26/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Allison SteckleyTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Faye Bremer conducted an unannounced Case Management inspection regarding capacity increase. Application was received in office requesting capacity increase from 148 to 160 Preschool children. LPA met with Director Allison Steckley and explained purpose of inspection.

LPA toured and inspected the physical plant, including but not limited to Rooms 1-10, outside play areas, restrooms, and common areas, with Director Allison. No changes were made to the indoor spaces or outdoor play spaces. LPA observed a sink used by children in each classroom. LPA observed Restroom #1 with 2 urinals, 4 toilets, and 5 sinks. Restroom #2 has 6 toilets and 5 sinks. Based on the amount of sinks available for children's use allows for a capacity of 300. Based on the amount of toilets and urinals available for children's use allows for a capacity of 180. Previous measurement taken on 09/15/2004 indicates a total indoor space of 5196.51 square feet for Rooms 1-8. Room 9 was added in 09/05/2006, for an additional 486.06 square feet. Room 10 was added in 05/08/2015 for an additional 432 square feet. Total classroom square footage is 6114.57, divided by 35 square feet allows for 174 children. Approved Fire Clearance allows for 160 children.

Based on capacity calculations and approved Fire Clearance, LPA recommends Licensing approval for capacity increase to 160 Preschool children.

Report reviewed and provided to Director Allison Steckley
SUPERVISOR'S NAME: Alma MaligTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Faye BremerTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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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