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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000829
Report Date: 01/16/2020
Date Signed: 01/16/2020 02:08:43 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 JEWISH COMMUNITY CENTER PRESCHOOLFACILITY NUMBER:
414000829
ADMINISTRATOR:FENYVES, RACHELFACILITY TYPE:
850
ADDRESS:800 FOSTER CITY BLVD.TELEPHONE:
(650) 378-2670
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY:300CENSUS: 196DATE:
01/16/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:Director, Rachel FenyvesTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Kassandra Medrano met with Director, Rachel Fenyves for an unannounced Case Management Inspection. The purpose of the inspection was to discuss an unusual incident that occurred on December 13, 2019; which was reported to the department by the center.

On the day mentioned above, facility was serving challah and in a brief moment a child with severe allergies got a hold a piece. Teacher removed the challah and reacted to a potential allergic reaction and administered epinephrin. They followed procedures set in place by calling emergency response team, as well as informing parents. Child showed no signs of allergic reactions and returned to school the following Monday.

LPA advised director and staff to be more cautious with the challah when serving the children.

SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
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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