414002676-6-6-2023-05-CC-MOLN-CSJP5G-20230606110042

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414002676
Report Date: 06/06/2023
Date Signed: 06/06/2023 11:00:51 AM

Document Has Been Signed on 06/06/2023 11:00 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	PENINSULA JEWISH COMMUNITY CENTER (SA)		FACILITY NUMBER:	414002676
ADMINISTRATOR:	LEVIN, STEPHANIE		FACILITY TYPE:	840
ADDRESS:	800 FOSTER CITY BLVD		TELEPHONE:	(650) 378-2762
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY:	120	CENSUS: 0	DATE:	06/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Nicole Francis/Jillian Johnson		TIME COMPLETED:	11:15 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On Jun 6, 2023 @ 8:00AM, Licensing Program Analyst (LPA) Maria Olguin-Leon met with Director, Nicole Francis, for an unannounced annual inspection at Peninsula Jewish Community Center After School Program. Purpose of inspection was explained. Program operates in five classrooms. Present today, Director and After School Care Assistant Director. No students were present during today’s visit. Facility is operating within capacity and in compliance with staff child ratio. Facility operates an after-school program from Monday to Friday 12:30PM – 6:00PM LPA, Director & Assistant youth director toured the facility and classrooms for health and safety hazards. Classrooms are clean with proper lighting and ventilation. There are plenty of age-appropriate toys/games, books, furniture, and learning materials all in good repair. Classrooms are equipped with working toilet and sinks with no running hot water. LPA reminded Director to have tight fitting lids on all containers. Outdoor playground area consists of asphalt area with basketball courts and an artificial grass area. The outdoor area is equipped with canopies to provide shade. LPA observed no safety hazards. LPA observed swimming pools located behind school which belongs to the community center. Facility has access to pool for usage of shallow area that is roped off for after school program usage. Pool is used once a week on a scheduled basis. Pool gate can only be opened by a staff badge and is properly locked and gated with a 5 ft. gate. The after-school program provides one snack for children. Snack schedules are posted on site. Food is properly stored and labeled in cabinets and refrigerator to avoid contamination. Children bring their own labeled water bottles. Facility offers filtered water for refills There is a fully equipped first aid kit located in each classroom. Incidental Medical Services were discussed, LPA observed medication to be properly stored and in first aid backpacks. Isolation area for sick children is in office. All cleaning products, chemicals, and toxins are inaccessible to children and locked in storage cabinets. Facility uses an electronic sign in / sign out program which is accessible with unique parental codes. Parents sign children out in the afternoon. After school care children are signed in by staff. Classrooms are equipped with dual carbon monoxide/smoke alarms system. All classrooms have a fully charged fire extinguisher. Classrooms are equipped with a working telephone landline and walkie talkies are used for communication. Cont. on page 2…

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PENINSULA JEWISH COMMUNITY CENTER (SA)	FACILITY NUMBER: 414002676
	VISIT DATE: 06/06/2023

NARRATIVE

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LPA reviewed 5 children’s records and 5 staff record. All children’s records and staff records were complete and up to date. The facility has all necessary paperwork posted, Facility License, Notification of Parent's Rights, Notification of Personal Rights, Car Seat Law, and Emergency Disaster Plan. Last emergency fire drill was conducted on February 21, 2023 and is properly documented. Per Director there are no firearms or weapons on site.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual – Regulations Interpretations and Procedures for Family Child Care Homes Section 102417. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll free ADA Information Line at (800) 514-0301 (voice)/(800)514-0383(TTY) and link to publication: Commonly Asked Questions about Child Care Centers and ADA, Available at: http://www/adagov/childqanda.htm.

Director was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

The Director was reminded about the Provider Information Notices (PINs) on the CCLD website. Licensee was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

As of January 1, 2018, all staff must complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com.

Cont. Page 3...

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: PENINSULA JEWISH COMMUNITY CENTER (SA)	FACILITY NUMBER: 414002676
	VISIT DATE: 06/06/2023

NARRATIVE

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LPA encouraged the Director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

As of today, no deficiencies were issued under CCR, Title 22, Division 12.

Exit interview conducted and report was reviewed with After-School Assistant Youth Director, Jillian Johnson.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Ali Zebila	TELEPHONE: (650) 266-8817
LICENSING EVALUATOR NAME: Maria Olguin-Leon	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

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