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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 410509197
Report Date: 05/14/2021
Date Signed: 05/14/2021 01:17:28 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:160CENSUS: 95DATE:
05/14/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Allison SteckleyTIME COMPLETED:
01:30 PM
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Due to the COVID-19 health crisis, a tele-inspection was conducted. Licensing Program Analyst (LPA) Van met with Site Director Allison Steckley for case management via Facetime. The Department received an application from the facility requesting a capacity increase on April 26, 2021. Currently, the facility is licensed for 160 preschool-age children and requesting an increase to the capacity of 164 preschool-age children. The Burlingame Central County Fire Department granted fire clearance on May 5, 2021.

Through FaceTime video chat, LPA and Site Director inspected room #11 for Health and Safety Hazards. Previously on July 14, 2020, the facility requested to add room #11 to the license, a case management was conducted, and room #11 was inspected and approved but was never measured. No changes were made to the previously licensed indoor spaces or outdoor play spaces. Due to the inspection being done virtually, the facility staff measured room #11. Room #11 has a measurement of 480 square feet, allowing approximately 14 additional children. The classroom appears clean and in good repair with sufficient lighting and ventilation. All furnishing and equipment are observed to be in good condition, and there are cubbies available for children's belongings. There were no changes in the number of sinks and toilets. The facility has a total of 20 sinks, allowing for 300 children and a total of 10 toilets and 2 urinals, allowing for 180 children.
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SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PENINSULA TEMPLE SHOLOM PRESCHOOL
FACILITY NUMBER: 410509197
VISIT DATE: 05/14/2021
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The facility currently has an outdoor waiver approved by the Department from the previous Pre-Licensing, that allowed the facility to have a total outdoor capacity of 122 children, and a rotation schedule is required.

The facility is recommended for a capacity increase to 164 preschool-age children.

This report was emailed to Site Director. The Site Director was advised that a follow-up inspection will be conducted in the future, and the measurement of the new classroom may be required.

This report will be kept in the facility file and made available for public review upon request. Desk duty is available Monday - Friday, 8:00am- 5:00pm. (650) 266-8800. Website for forms and regulations: www.cdss.ca.gov.
SUPERVISOR'S NAME: Garfield LeungTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Brendon VanTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
LIC809 (FAS) - (06/04)
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