430709398-4-11-2023-07-CC-KMEO-CQSQSN-20230411122550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 430709398
Report Date: 04/11/2023
Date Signed: 04/11/2023 12:26:00 PM

Document Has Been Signed on 04/11/2023 12:26 PM - 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 JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	ADDISON PENZAK JEWISH COMMUNITY CENTER		FACILITY NUMBER:	430709398
ADMINISTRATOR:	CYNDI SHERMAN		FACILITY TYPE:	850
ADDRESS:	14855 OKA ROAD		TELEPHONE:	(408) 357-7417
CITY:	LOS GATOS	STATE: CA	ZIP CODE:	95032
CAPACITY:	180	CENSUS: 12	DATE:	04/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Cyndi Sherman		TIME COMPLETED:	12:40 PM

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	Licensing Program Analyst (LPA) Kassandra Medrano met with Cyndi Sherman, Director, and Anna Hurst, Associate Director, for an unannounced required – 1-year annual inspection. Upon Arrival director stated that facility is currently closed for Passover week. There were 12 children present, 4 staff. LPA toured the indoor and outdoor areas of the Facility during today's inspection. During the inspection classrooms were not in use and in the process of "spring cleaning" except for room 8 and 6 for nap. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), menus, and Activity Schedule. Days and hours of operation are Monday through Friday, 7:30 am-5:30pm. The preschool age program is Licensed in Rooms 1,2,3,4,5, 7,8,9,10,11. Currently only using classroom: 1-9. The preschool program also has a toddler option that is only licensed in rooms 4 & 5. The preschool program operates on Addison Penzak Jewish Community Center. There is also a school and school age program not associated to the license. The following was observed today, program has an outdoor space waiver allowing for program to operate without having required outdoor space for play. The waiver states that yard cannot exceed 165 children at a time, and play schedules to be posted. LPA reviewed 13 children's and 6 staff files during today's inspection. Each child's file reviewed contains the required documents, including the Information and Emergency Information form (LIC 700) and immunization records. All staff files reviewed contain the required documents, including transcripts/verification of experience/immunization records, and Health Screening Report. All staff have current certificates of completion of the Mandated Reporter Training for Child Care Workers on file. Last fire/disaster drill was completed on 2/16/2023. The staff files that were reviewed have current CPR and First Aid certifications on file. Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). LPA observed that the teacher/child ratio was in compliance during today's inspection. Director understands the conditions, limitations, and capacity specifications of the Facility license. Director understand that children shall be visually supervised at all times. Any child(ren) who exhibit symptoms of illness including, but not limited to, fever or vomiting, are not accepted in care. Any child(ren) who become ill during the day, shall be isolated in the front office area.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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 JOSE-DAY CARE, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: ADDISON PENZAK JEWISH COMMUNITY CENTER	FACILITY NUMBER: 430709398
	VISIT DATE: 04/11/2023

NARRATIVE

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The Facility has adequate ventilation, including central air conditioning/heating. Director understands that the Facility must be kept free of flies and other insects & rodents. Facility has conducted its required lead testing for their water sources and have received "pass" on 11 fixtures as of 10/5/22. Drinking water is readily available for the children in the Facility and in the outdoor playground area via cleared water bubblers as well as staff bring out the children's personal water bottles. LPA observed all bottles labeled with children's names. Staff and children's bathrooms are clean, sanitary, and operable. Director states that there are no weapons or firearms on the premises. The Facility has functioning carbon monoxide detectors in the Facility.
The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. The parents are required to provide lunches and snacks for their children. Parents do have the option to purchase hot lunch through "My Green Lunch," parents deal directly with the food program. The food program is vegetarian and nut free. The Facility has trash cans with tight fitting lids for solid waste. Cleaning supplies are inaccessible to the children and stored in high cabinets inaccessible to children.
This facility provides IMS. A review of storage of medications, equipment and supplies, and reviewed children, personnel and administrative records. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.
The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. The program has exclusive use to the preschool and toddler yards. LPA observed that the outdoor equipment is age appropriate and in good condition. Shade is provided by trees and building overhangs in the playground. LPA did not observe any bodies of water. Director states that the Facility does not provide transportation.
Cyndi, director, was reminded that all adults 18 and over, 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 Child Care Center. 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.
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.

Exit interview conducted and report was reviewed with the Director, Cyndi. No deficiencies cited during today's inspection. A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Diana Stephenson	TELEPHONE: (408) 324-2128
LICENSING EVALUATOR NAME: Kassandra Medrano	TELEPHONE: (408) 497-7322
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC809 (FAS) - (06/04)

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