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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434404443
Report Date: 09/20/2021
Date Signed: 09/20/2021 03:26:27 PM

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:TEMPLE EMANU-EL PRESCHOOLFACILITY NUMBER:
434404443
ADMINISTRATOR:SMEAD, BARBARAFACILITY TYPE:
850
ADDRESS:1010 UNIVERSITY AVENUETELEPHONE:
(408) 293-8660
CITY:SAN JOSESTATE: CAZIP CODE:
95126
CAPACITY:90CENSUS: 0DATE:
09/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Barbara SmeadTIME COMPLETED:
03:59 PM
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Licensing Program Analyst (LPA), Pete Hernandzez conducted an unannounced Required 1 Year inspection to the Facility today. LPA met with Ms. Barbara Smead, Director, and explained the nature of today's visit to her. LPA toured the Facility both inside and outside during today's visit. LPA notes that the Facility is licensed in Rooms 11-15, Room 20 (upstairs) and Temple House on the premises of the Temple Emanu-el. 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), Menu, and Activity Schedule. The facility has two waivers on file for the occasional use of the Sanctuary and Patio and the playground capacity.

Each child's file reviewed contains the required information. LPA reviewed five staff files and found that all have completed the required Mandated Reporter Training (AB1207) and the required immunization's against Pertussis, Measles, and Influenza (or opt out letter). The Director, and eleven staff have current CPR and First Aid certifications on file. Ms. Smead 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 Reviewed the files of 10 children in care and 5 Staff files. All the required documentation was in the file. Ms. Smead understands the conditions, limitations, and capacity specifications of the Facility license. Ms. Smead understands that children shall be visually supervised at all times.

A review of staff records today indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA reminded the Director of applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12-month period.

REPORT CONTINUED ON THE FOLLOWING PAGE (REPORT DATED 09/20/2021):
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TEMPLE EMANU-EL PRESCHOOL
FACILITY NUMBER: 434404443
VISIT DATE: 09/20/2021
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CONTINUATION OF PREVIOUS PAGE (REPORT DATED 09/20/2021):
LPA observed that all rooms are clean and safe for all children and staff. Ms. Smead states that the Facility has a third-party cleaning service that cleans the Facility Monday through Friday in the evenings. Drinking water is readily available for the children in each room and in the outdoor playground area via water fountains and personal water bottles. LPA observed solid waste containers with tight-fitting lids in the Facility. Staff and children's bathrooms are clean, sanitary, and operable. There is a separate staff bathroom not utilized by the children which an isolated child can use if needed. Ms. Smead states that there are no weapons or firearms on the premises.

The food preparation and storage areas are clean, free of litter & rubbish, and free of rodents and other vermin. Cleaning supplies are inaccessible to the children and stored in locked cabinets inaccessible to children. Any medications at the Facility are stored in a lock box in the Directors office.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground area utilized by children is surrounded by appropriate fencing and the outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in good condition. The resilient materials (wood chips) in the outdoor playground area are sufficient. LPA did not observe any bodies of water.

LPA provided the Community Care Licensing’s website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised the licensee of their responsibility to stay current in regard to new regulations. LPA also provided the e-mail address for the advocates in order to be added to the quarterly newsletter mailing list childcareadvocatesprogram@dss.ca.gov.

LPA discussed Assembly Bill (AB) 2370 and gave Lead Safety information.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: TEMPLE EMANU-EL PRESCHOOL
FACILITY NUMBER: 434404443
VISIT DATE: 09/20/2021
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TYPE A language: Should there ever be issuance of Type A citations today, a copy of the Facility Evaluation Report LIC809 has to be posted on the wall and a copy to be given to all parents of currently and newly enrolled children for next 12 months. In addition, copy of LIC9224 Statement Acknowledging Receipt of Licensing Reports need to be signed and kept in child files.

A deficiency is NOT being cited based on the LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted and reviewed and developed with the Licensee. A copy of this report and appeals rights were discussed and left with the Licensee, Barbara Smead, whose signature on this form confirm receipt of these documents.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE ENTRANCE TO THE FACILITY, AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 334-2151
LICENSING EVALUATOR NAME: Pietro HernandezTELEPHONE: (408) 598-9250
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021
LIC809 (FAS) - (06/04)
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