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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 12:53:29 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:Annual/RandomUNANNOUNCEDTIME 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 Annual inspection. LPA met with Director Allison Steckley and explained purpose of inspection. There were 126 Preschool children, with 19 teachers present during today's 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. 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. Both restrooms and changing areas are kept clean, in good repair, and maintained with adequate supplies. The center appears to be clean and orderly, with sufficient lighting and at a comfortable temperature. Furniture, equipment, and toys were observed to be sufficient, age appropriate and in good repair. Children's cubbies are in the main hallway, outside of each classroom. Program provides AM and PM snacks, and children bring their own lunches. Center has all required postings. Emergency Drills are conducted and logged, with last drill conducted on May 28, 2019. Charged fire extinguisher was observed in hallway, with smoke and carbon monoxide detectors throughout. The center has a hardwired sprinkler system. The outdoor area is fenced, is clean, with sufficient cushioning underneath the climbing structures. Drinking water is readily available to children both indoors and outdoors. Cleaning products and Toxins are maintained inaccessible to children.

LPA reviewed a sample of staff and children's files. All staff are fingerprint cleared and associated to the center. Staff files have all required forms and documents. Children's files have all required signed assessments and agreements on file.

In order to keep our records current, the following forms are requested to be updated and submitted to CCL by October 10, 2019:
LIC 308 - Designation of Administrative Responsibility
LIC 500 - Personnel Report

No Deficiencies are cited during today's inspection.
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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