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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434410805
Report Date: 01/03/2022
Date Signed: 01/03/2022 04:09:59 PM


Document Has Been Signed on 01/03/2022 04:09 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
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:T'ENNA PRESCHOOL AT THE OSHMAN FAMILY JCCFACILITY NUMBER:
434410805
ADMINISTRATOR:MYKENZIE BUSSERFACILITY TYPE:
850
ADDRESS:3921 FABIAN WAYTELEPHONE:
(650) 223-8788
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:250CENSUS: 122DATE:
01/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lauren Berman
Mykenzie Busser
TIME COMPLETED:
04:30 PM
NARRATIVE
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On 01/03/2022 at approximately 9:30am Licensing Program Analysts (LPAs) Sabina Dodoo & Christina Uribe conducted an Unannounced Case Management Visit and met with Director Lauren Berman. During today’s visit there were 122 children present & 47 staff members. The purpose of today’s visit is to investigate an unusual incident which was reported to the Department on 12/10/21 in which two children (C1 & C2) left the supervised pick-up area without supervision. The children were reportedly unattended for 30 seconds, however during individual interviews with/ S1, S2, S3, & S4 it was discovered that the children were unaccounted for a longer period of time.

File Review: At 10:00am LPAs reviewed Facility Roster, Personnel Record, Sign In/Out Sheets for day of incident, list of staff present for day of incident & classroom rosters. LPA Uribe compared list of staff with association list for the facility and found that S5 did not have eligible background clearance which results in a Type A Violation which comes with an immediate civil penalty. LPAs were able to review all files from facility to aide in the inspection process for the incident in question.

Interview of Incident: LPAs interviewed all teachers in the Irit Classroom and the Director & Asst. Director starting at 12:00pm. One teacher however (S7) was not present during today’s inspection and therefore was not available for interview. S1 & S2 stated that the children were gone 1-2 minutes, S3 stated the children were gone for about 5 minutes, & S4 stated the children were gone between 10-15 minutes. After record review and comparing the children’s sign in and out sheets for the day of the incident, LPAs found the children were gone for at least 4 minutes. S4, S6, & S7 took the children out of the classroom in a single line out to the designated pick up area which is located in the courtyard of a large common area of the campus outside of the preschool gates.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2022
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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: T'ENNA PRESCHOOL AT THE OSHMAN FAMILY JCC
FACILITY NUMBER: 434410805
VISIT DATE: 01/03/2022
NARRATIVE
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Children were placed to sit on a blanket while their parents arrived to pick them up. S3 was inside of the classroom with one child while the other teachers brought the line outside. Shortly after bringing the children outside, S6 clocked out for the day and left S4 & S7 with the line of children. At 12:48pm, S3 brought C3 out of the classroom into the courtyard area where her parent picked her up. Immediately after C3 was picked up, S3 met S4 & S7 at the designated pick up area where she noticed that two children were missing. S3 stayed at the pick up area while S4 & S7 left to go look for C1 & C2. At 12:52pm, C1’s mother began the sign out process to pick him up, however S3 stated that the children were found and returned about a minute after that time. This provides evidence that C1 & C2 were unaccounted for during at least a 4 minute time frame.

LPA Dodoo walked the same path from the pick-up area to where the children were found and assessed that the children were out immediate and direct supervision. Resulting in a Type A Violation which comes with an immediate civil penalty due to the Department’s zero tolerance policy. Facility has already implemented a new pick up and drop off procedure which is located inside the preschool gates which started on 12/13/2021. See attached LIC 809D for further plan of correction.

The attached Type A violations are cited today and must be corrected by the due date. Upon receipt the licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians newly enrolled at the facility during the next 12 months. All parents/guardians must sign an acknowledgement form of proof or receiving this report (LIC9224). The LIC9224 must be placed in the child’s file to be reviewed by licensing.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the facility representative Lauren Berman.
SUPERVISOR'S NAME: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/03/2022 04:09 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612


FACILITY NAME: T'ENNA PRESCHOOL AT THE OSHMAN FAMILY JCC
FACILITY NUMBER: 434410805

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
01/03/2022
Section Cited

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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 obtain a California clearance or
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criminal record exemption as required by the Department
This requirement is not met as evidence by: Based file record review the licensee did not comply with the section cited above.
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Under Appeal
Type A
02/03/2022
Section Cited

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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This requirement is not met as evidence by: Based on interview the licensee did not comply with the section cited above in which poses immediate health, safety, or personal right risk to persons in care.
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for proper care and supervision is available at www.cdss.ca.gov. Licensee will mail/email a copy of the meeting agenda and signed attendance sheet from each staff for proof of attendance of the meeting.
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: Chandra CharlesTELEPHONE: (510) 286-0966
LICENSING EVALUATOR NAME: Sabina DodooTELEPHONE: 510-622-2602
LICENSING EVALUATOR SIGNATURE:
DATE: 01/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/03/2022
LIC809 (FAS) - (06/04)
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