434410805-10-10-2024-52-CC-JZHU-D9WVC5-20241010161833

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434410805
Report Date: 10/10/2024
Date Signed: 10/10/2024 04:18:44 PM

Document Has Been Signed on 10/10/2024 04:18 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME:	T'ENNA PRESCHOOL AT THE OSHMAN FAMILY JCC		FACILITY NUMBER:	434410805
ADMINISTRATOR/ DIRECTOR:	MYKENZIE BUSSER		FACILITY TYPE:	850
ADDRESS:	3921 FABIAN WAY		TELEPHONE:	(650) 223-8788
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY: 250	TOTAL ENROLLED CHILDREN: 250	CENSUS: 179	DATE:	10/10/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:10 AM
MET WITH:	Ilana Gelemovich, Mykenzie Busser		TIME VISIT/ INSPECTION COMPLETED:	04:30 PM

NARRATIVE

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On 10/10/2024 at 9:10am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu met with Director Ilana Gelemovich and Assistant Director Mykenzie Busser for an unannounced annual inspection. Also present during the inspection were 38 fingerprint-cleared staff, and 179 children (27 toddlers and 152 preschoolers) in care. The facility is within ratio and in compliance with capacity regulations today. Upon arrival, LPA provided director a copy of the Entrance Checklist (LIC 125). The facility was toured to conduct a Health and Safety Inspection. The facility’s current hours of operation are Monday - Friday from 8:00am - 6:00pm. The facility is a preschool licensed with a toddler (18-30 months of age) component. LPA observed the indoor and outdoor spaces for the toddler component are physically separate from the preschool license.

Classrooms: This facility is licensed with 14 classrooms, and all classrooms are currently in use. All classrooms were inspected for age-appropriate furnishings, equipment, and adequate storage for children’s belongings. LPA observed the cleanliness of floors and surfaces. The facility is equipped with telephone service, wired smoke and carbon monoxide detectors, pull-down fire alarms, and fully charged fire extinguishers that are accessible throughout the facility. Fully stocked first-aid kits are available in the classrooms. LPA inspected the napping equipment and observed them to be stored in a healthful manner. Bedding is brought from home. Drinking water is accessible by children in the classrooms. The isolation area for when a child is sick is the Parent Lounge.

Food Service Areas: The facility provides AM/PM snacks to children in care. Children bring meals from home. All center provided food items are properly labeled and stored separately from cleaning supplies. Food prep area is clean, adequately equipped, and free from hazardous materials. Snack menus are posted and were reviewed. Solid waste bins are equipped with tight fitting lids.

Bathrooms & Changing Stations: Facility has separate staff and child designated bathrooms. Toilets and faucets are in safe, sanitary, and operating condition. The children are able to reach the sinks, toilets, and supplies. LPA observed the changing stations to be set-up and maintained according to Title 22 regulations. Page 1 of 3. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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 7

Document Has Been Signed on 10/10/2024 04:18 PM - It Cannot Be Edited

Created By: Jialing Zhu On 10/10/2024 at 03:32 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 10/10/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above as 4 of 14 staff files reviewed by LPA did not have proof of MMR (measles) immunization. 1 of 14 staff files reviewed by LPA did not have proof of Tdap immunization, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/11/2024
	Plan of Correction
1 2 3 4	Director will obtain proof of MMR immunizations for the 4 staff members. Director will also obtain proof of Tdap immunization for the 1 staff. Director will email the proofs of immunizations to LPA at jialing.zhu@dss.ca.gov by 11/11/2024.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Charles

LICENSING EVALUATOR NAME:

Jialing Zhu

LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC809 (FAS) - (06/04)

Page: 2 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: T'ENNA PRESCHOOL AT THE OSHMAN FAMILY JCC	FACILITY NUMBER: 434410805
	VISIT DATE: 10/10/2024

NARRATIVE

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Outdoor Play Area: The outdoor play areas are fenced. All equipment and surfaces are free from hazards. There is ample shade available. There are age-appropriate outdoor toys and materials for the children. The play structures are securely installed into the ground. The ground surrounding the play structures is sufficiently padded with rubber mats or turf and in good condition for safety. The outdoor area also has multiple gardens and sandboxes. Drinking water is accessible by children outdoors. There are no pools or similar bodies of water accessible to children.

Files and Record Keeping Review: LPA reviewed the facility roster and personnel report and copies were obtained. All individuals subject to criminal record review have a clearance and/or exemption and have been associated to the facility. LPA reviewed 14 staff files. At least one opening/closing staff member has a current Pediatric CPR/First-Aid Certification. Director’s CPR/First-Aid Certificate is current and expires on 10/22/2025. Mandated Reporter Training certificates were reviewed and current. Director’s Mandated Reporter training certificate expires on 05/01/2026. LPA reviewed 12 children’s files. The center utilizes an electronic sign-in/out system and is in compliance with sign in and out procedures. Fire/disaster drills are performed at least once every six months. The last drill was a fire drill conducted on 05/29/2024. Per director, there are no firearms on the premises. All required documents, including the menu and waivers, are posted in a publicly accessible area.

Record Keeping and Reporting Requirements: Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Personnel and facility roster must be properly maintained, and fire/disaster drills must be conducted at least every six (6) months and documented. Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within seven (7) business days. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov.

Criminal Record Clearance: Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Page 2 of 3. See LIC 809C.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC809 (FAS) - (06/04)

Page: 5 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: T'ENNA PRESCHOOL AT THE OSHMAN FAMILY JCC	FACILITY NUMBER: 434410805
	VISIT DATE: 10/10/2024

NARRATIVE

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Lead Testing: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS): This facility does provide Incidental Medical Services (IMS). LPA observed medications are stored securely and are made inaccessible to children in care. LPA checked three (3) children’s medication. For IMS information see PIN 22-02-CCP. 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 the ADA, available at http://www.ada.gov/resources/child-care-centers/.

One (1) Type B deficiency and three (3) Advisory Notes (Technical Violations) were issued during today’s inspection.

Type B Deficiency: 4 of 14 staff files reviewed by LPA did not have proof of MMR (measles) and/or Tdap (pertussis) immunization.

Advisory Notes (TVs):

· 6 of 6 infant files reviewed by LPA did not have Infant Needs & Services Plans.

· 1 of 14 staff files reviewed by LPA did not have a LIC 503 Health Screening Report and/or TB test results.

· Children’s medication: one (1) child's medication have two (2) expired Epipens. The same child also has a box of Epipens that is not prescribed to them but for their sibling. The other children's medications were not accompanied by LIC 9221.

A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted, report was reviewed, and Appeal Rights were provided to Director Ilana Gelemovich.

Page 3 of 3. End of Report.

SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Jialing Zhu
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC809 (FAS) - (06/04)

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