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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013420547
Report Date: 09/10/2024
Date Signed: 09/10/2024 03:45:19 PM

Document Has Been Signed on 09/10/2024 03:45 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 CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:TEMPLE SINAI PRESCHOOLFACILITY NUMBER:
013420547
ADMINISTRATOR/
DIRECTOR:		PERITORE, MOLLYFACILITY TYPE:
850
ADDRESS:2808 SUMMIT ST.TELEPHONE:
(510) 451-3263
CITY:OAKLANDSTATE: CAZIP CODE:
94609
CAPACITY: 124TOTAL ENROLLED CHILDREN: 62CENSUS: 53DATE:
09/10/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Molly PeritoreTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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On 09/10/2024 at 12:00 PM Licensing Program Analyst (LPA), A. Curry conducted an unannounced case management visit to follow up with the Director, Molly Peritore, regarding the lead testing requirements. LPA met with the Director, Molly Peritore, to explain the purpose of today's visit. During the visit on 08/30/2023 the director provided a document from the city of Oakland that indicates the facility was constructed after January 01, 2010. Shortly after the visit, the director was advised that the building permit is required to waive the lead testing requirement. During today's visit, the Director mentioned that the facility is having difficulties obtaining the building permit, but may decide to test the drinking water for lead contamination instead. Since LPA is not able to retrieve the building permit during today's visit a Type B citation will be issued.

Notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, appeal rights were given, and report was reviewed with the Director, Molly Peritore.
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2024
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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Document Has Been Signed on 09/10/2024 03:45 PM - It Cannot Be Edited


Created By: Ashley Curry On 09/10/2024 at 02:32 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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: TEMPLE SINAI PRESCHOOL
FACILITY NUMBER: 013420547

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2024
Section Cited
HSC
1597.16(a)(1)

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ยง1597.1(a) (1) A licensed child day care center.. located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.
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By 10/10/2024 email LPA building permit or test drinking water for lead contamination. Email LPA the appointment confirmation.

If lead testing is conducted, please email LPA the following documents:
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This requirement is not met as evidence by: Based on interview and record review the licensee did not comply with the section cited above by not testing its drinking water for lead contamination or providing a building permit that indicates the building was constructed after 01/01/2010, which poses a potential risk to the health and safety for children in care.
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Test results
Facility sketch that identifies the outlets that were tested
LIC 9275 form
LIC 9276 form

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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:Monica Mathur
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024


LIC809 (FAS) - (06/04)
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