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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573610796
Report Date: 03/07/2022
Date Signed: 03/07/2022 12:12:47 PM


Document Has Been Signed on 03/07/2022 12:12 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:GAN HAVERIM PRESCHOOLFACILITY NUMBER:
573610796
ADMINISTRATOR:CAREN WILKERSONFACILITY TYPE:
850
ADDRESS:1715 ANDERSON ROADTELEPHONE:
(530) 758-0842
CITY:DAVISSTATE: CAZIP CODE:
95616
CAPACITY:65CENSUS: DATE:
03/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Tsoliang Wang, TeacherTIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Salene Mayberry and Licensing Program Manager (LPM) Bettina Engelman met with teacher Tsoliang Wang for the purpose of an unannounced case management inspection. Licensee representatives have recently requested to add a classroom to facilitate physical distancing during the COVID-19 pandemic. The request was to add the South Classroom, which is next to the Redwood Classroom, while maintaining total licensed capacity of 65. Prior to today's inspection, LPA Mayberry confirmed receipt of the fire clearance.

A health and safety inspection was conducted in all areas accessible to children. The additional space appears free of hazards and safe for preschool children. Licensing staff measured the classroom (South classroom which is next to the Redwood classroom). The total square footage of the South Classroom is 519.75 square feet. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

The outdoor activity space will remain the same. Effective today, 3/7/2022, facility is approved to use the South Classroom.

Director was encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. The licensee's signature on this form acknowledges receipt of this form.

An exit interview was conducted and in the areas that were evaluated, no deficiencies were observed at the time of the inspection. A Notice of Site Visit was provided and should remain posted for 30 days for parental review.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Salene MayberryTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2022
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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