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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002676
Report Date: 10/05/2020
Date Signed: 10/05/2020 12:24:49 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 (SA)FACILITY NUMBER:
414002676
ADMINISTRATOR:LEVIN, STEPHANIEFACILITY TYPE:
840
ADDRESS:800 FOSTER CITY BLVDTELEPHONE:
(650) 378-2762
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY:120CENSUS: 32DATE:
10/05/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Director, Stephanie LevinTIME COMPLETED:
12:30 PM
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On October 5th, 2020 at 11:45 am, Licensing Program Analyst (LPA) Kassandra Medrano met with Director, Stephanie Levin via FaceTime due to COVID-19 state of emergency. The purpose of the visit was explained, to inspect the added room. Facility has requested an additional room to provide enough space for the children to properly social distance. Levin states they are not currently using this room, but have requested room to be able to maintain their capacity to met COVID-19 health and safety requirements. The facility has plans of using "Classroom A/B" that is located within the Peninsula Jewish Community Center. The room has age appropriate materials and desks for the virtual learning. The room that is planned for use has received fire clearance. But, the building inspectors have not cleared the room for use, due to there not being a separating wall to divide care from community center. Levin states when the facility has an increased demand for children they will proceed with the wall request and notify RO with that update. The facility has also requested a waiver operate temporarily with extended hours due to schools not being open to accommodate the need for virtual learning for school age children.

Waiver to be processed, and once approved to be posted. No deficiencies cited.
SUPERVISOR'S NAME: Ali ZebilaTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Kassandra MedranoTELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2020
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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