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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 430701148
Report Date: 06/03/2021
Date Signed: 06/04/2021 09:33:12 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:SOUTH PENINSULA HEBREW DAY SCHOOLFACILITY NUMBER:
430701148
ADMINISTRATOR:SALMAN, LIATFACILITY TYPE:
850
ADDRESS:1030 ASTORIA DRTELEPHONE:
(408) 738-3060
CITY:SUNNYVALESTATE: CAZIP CODE:
94087
CAPACITY:135CENSUS: 66DATE:
06/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:41 AM
MET WITH:Hang DangTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) met with Licensee representative, acting director, Hand Dang and Rabbi Perry Tirschwell for a Case Management inspection. LPA toured 5 classrooms and observed the following in each classroom:
Classroom #1 12 children and staff Melisa Davila, Leah Koren, and Lidia Silva.
Classroom #2 13 children and staff Dana Bar Ziv, Melisa Patel.
Classroom #3 14 children and staff Monica Jimenez, Liat Koren, and Sunha Lee.
Classroom #4 14 children and staff Ilanit Lazmi, Chen-Hui Ma Fan, and Danielle Perrine.
Classroom #5 13 children and staff Katie Erez, and Yamilex Aguirre.
LPA observed that classroom #1 which is the classroom for the toddler option (ages 18 to 36 months). LPA observed the following children: Ch # 1 who has turned 3 years on 4/1/21 is still in the toddler classroom, also in the same classroom were Ch #2, and Ch #3 who are 37 months old, and Ch #4 who turned 36 months on 5/5/2021.
LPA observed that staff #1 Melisa Davila Oconor and staff #2 Lidia Silva Medina both working for the center and who were hired on 9/23/2021 and 9/16/2020 respectively do not show association to the facility in the Licensing Information System (LIS), as of today and they are cleared as of today’s date 6/03/2021.

Report dated 6/3/2021 continues on page 2.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SOUTH PENINSULA HEBREW DAY SCHOOL
FACILITY NUMBER: 430701148
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/03/2021
Section Cited

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(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)
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This requirement was not met as evidenced by: Licensee allowed staff #1, #2, and #3, to be in contact with children without being associated to the Center. This poses an immediate risk to the health, safety or Personal rights to children in care.
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the next 12 months per AB633 requirements.
Licensee was advised to obtain signature on form LIC9224 (form was provided to Director) from each child’s parent or representative that they have received a copy of this report.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: SOUTH PENINSULA HEBREW DAY SCHOOL
FACILITY NUMBER: 430701148
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2021
Section Cited

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a) Licensees serving preschool-age children may create a special program component for children who are between 18 months and 36 months of age. The provisions of Sections 101151 through 101239.2 shall apply for children over 24 months, in addition to those specified in Health and Safety Code section 1596.955. The provisions of Sections 101351 through 101439.1 shall apply for children
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between the ages of 18 and 24 months participating in a preschool toddler component, in addition to those specified in Health and Safety Code section 1596.955. This requirement was not met as evidenced by: Ch 1, Ch 2, Ch 3,and Ch 4 all over 36 months were observed in the toddler classroom. This poses a potential risk to the health and safety of the children in care.
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Type B
06/17/2021
Section Cited

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(1) If the child care center director is absent for more than 30 consecutive calendar days, the substitute director shall meet the qualifications of a director. This requirement was not met as evidenced by: Rabbi Perry stated by email on 5/27/2021 that he himself was acting as the director since 4/21/2021 without
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submitting any documentation that verify he meets the minimal qualifications to be the facility Director. This poses a potential risk to the Health and Safety of the children in care.The center has submitted, for revision, Director's qualifications packet to Licensing Department on 5/29/2021
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 06/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/03/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: SOUTH PENINSULA HEBREW DAY SCHOOL
FACILITY NUMBER: 430701148
VISIT DATE: 06/03/2021
NARRATIVE
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Report dated 6/03/2021 continues from page 1.

LPA also noticed that staff #3 Fan Chan-Huii who was hired on 9/14/2020 requested association to the center on 4/22/2021.

The following type A and B deficiencies were cited on the attached pages (809-D). A $1500.00 civil penalty has been assessed today as staff #1, #2, and #3 were not associated to the facility prior to starting to be in contact with the children in care. Licensee was informed that failure to correct the deficiencies by the specified Plan of Correction (POC) due date may result in assessment of additional civil penalties in the amount of $100 per day per violation until the correction is made.

An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Licensee.

NOTICE OF SITE VISIT WAS PRINTED AND MUST BE POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4