434412177-8-1-2022-52-CC-MOTI-CGVPZ5-20220801114459

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434412177
Report Date: 08/01/2022
Date Signed: 08/01/2022 11:45:05 AM

Document Has Been Signed on 08/01/2022 11:45 AM - 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:	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:	168	CENSUS: 0	DATE:	08/01/2022
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Cyrus Mallare		TIME COMPLETED:	11:50 AM

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) Melanie Otsuji conducted a Case Management - Other Inspection at the facility on today's date, 8/1/2022. Upon arrival, LPA observed that there were currently no school-age children on site as it was summer break. Facility will reopen August 11, 2022. LPA met with Director, Cyrus Mallare. The purpose of the inspection was to ADD 1 room as licensed space (G103). The facility is currently applying for an Increase of Capacity to serve a total of 192 children ages 5-12. LPA also conducted measurements of newly added room. 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, E104 are as follows: 5868.52 SQF -NEWLY ADDED Classroom G103 38 X 24.08 MINUS 20.88 ENCUMBERED SPACE = 894.16 SQF Total Measurements: INDOORS: 6762.68 SQUARE FEET = 193 CHILDREN OUTDOORS: 15990.43 SQUARE FEET = 213 CHILDREN The center has obtained an approved fire clearance from Palo Alto Fire Department on 7/20/2022. The fire clearance is approved with a capacity of 192 school aged children. Club J at the Oshman will have 8 approved classrooms (E104, D120, D123, M121, M117, G100, G103 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: 08/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022

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: CLUB J AT THE OSHMAN FAMILY JCC	FACILITY NUMBER: 434412177
	VISIT DATE: 08/01/2022

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. Incidental 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.

License to operate out of 8 classrooms (D120, D123, M121, M117, E104, G100, G103, and Second Floor Pavilion) will be effective as of today's date, 8/1/2022.

An exit interview was conducted with Director, Cyrus Mallare.

SUPERVISOR'S NAME: Wynn Norona	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR NAME: Melanie Otsuji	TELEPHONE: (510) 622-2613
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022

LIC809 (FAS) - (06/04)

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