434412177-6-21-2021-52-CC-MOTI-C47S4G-20210621133243

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412177
Report Date: 06/21/2021
Date Signed: 06/21/2021 01:32:49 PM

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:	CLUB J AT THE OSHMAN FAMILY JCC		FACILITY NUMBER:	434412177
ADMINISTRATOR:	MALLARE, CYRUS		FACILITY TYPE:	840
ADDRESS:	3921 FABIAN WAY		TELEPHONE:	(650) 223-8625
CITY:	PALO ALTO	STATE: CA	ZIP CODE:	94303
CAPACITY:	174	CENSUS: 0	DATE:	06/21/2021
TYPE OF VISIT:	Case Management - Licensee Initiated	ANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Cyrus Mallare		TIME COMPLETED:	02:00 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 Manager (LPA) Melanie Otsuji conducted an Announced Case Management - Other Inspection at the facility on today's date, 6/21/2021. Upon arrival, LPA observed that there were currently no school-age children on site as it was summer break. Facility will reopen August 12, 2021. LPA met with Director, Cyrus Mallare. The purpose of the inspection was to REMOVE 2 rooms from licensed space (G103 and D117) and ADD (E104). The facility is currently applying for an Increase of Capacity to serve a total of 217 children ages 5-12. LPA also conducted measurements of newly added room(s). Hours of Operation are: M-F 8:30AM-6:00PM. LPA conducted a health & safety inspection of the facility. -Previously measured space for Second Floor Pavilion, D120, D123, M121, M117, and G100 are as follows: 4733.68 SQF -NEWLY ADDED Classroom E104 42 x 27.02 = 1134.84 SQF Total Measurements: INDOORS: 5868.52 SQUARE FEET = 168 CHILDREN OUTDOORS: 15990.43 SQUARE FEET = 213 CHILDREN The center has obtained an approved fire clearance from Palo Alto Fire Department on 6/3/2020. The fire clearance is approved with a capacity of 217 school aged children. Club J at the Oshman will have 7 approved classrooms (E104, D120, D123, M121, M117, G100 and Second Floor Pavilion) for School Aged children. Facility will also have 4 play yards (Outdoor Field Area, 2nd Floor Pavilion Patio, Gaga Pit and Preschool Play Yard) available for children. The school age rooms are equipped with varied age appropriate materials and equipment.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

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, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: CLUB J AT THE OSHMAN FAMILY JCC	FACILITY NUMBER: 434412177
	VISIT DATE: 06/21/2021

NARRATIVE

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There are 23 toilets, 9 urinals and 26 sinks available for children use. The staff have a separate bathroom on the 4th floor of the theater. Director's office and bathroom nearest Director's office will serve as isolation areas for ill children. Individual Medical Services (IMS) policy was discussed. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301

All licensing required documents are posted. Zero Tolerance policies were explained. Notice of Site Visit form was provided and posted. The center was found to be clean, safe, sanitary and in good repair. There were no deficiencies cited during this visit.

LPA has added Classroom E104 to the license. However, due to removal of G103 and D117, facility will have to DECREASE their licensed capacity to from 174 to 168 School Aged Children effective today, 6/21/2021.

An exit interview was conducted.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

LIC809 (FAS) - (06/04)

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