013423769-1-2-2025-02-CC-ASIS-DCJRAL-20250102115120

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423769
Report Date: 01/02/2025
Date Signed: 01/02/2025 11:51:28 AM

Document Has Been Signed on 01/02/2025 11:51 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	TEMPLE SINAI PRESCHOOL		FACILITY NUMBER:	013423769
ADMINISTRATOR/ DIRECTOR:	MOLLY PERITORE		FACILITY TYPE:	860
ADDRESS:	2808 SUMMIT ST		TELEPHONE:	(510) 903-5228
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94609
CAPACITY: 28	TOTAL ENROLLED CHILDREN: 28	CENSUS: 0	DATE:	01/02/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:30 AM
MET WITH:	Molly Peritore		TIME VISIT/ INSPECTION COMPLETED:	11:15 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	Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) Alecia Sifuentes met with Director Molly Peritore for the purpose of a Change of Components Served prelicensing inspection. Licensee requests a toddler component for 41 toddlers ages 18-36 months and a preschool component for 83 children ages two years to entry into kindergarten for a total capacity of 124. The program will operate Monday through Friday from 8:00 a.m. to 6:00 p.m. The fire clearance was granted and received on 6/4/2024. Parents provide all meals. LPA informed the Director that the facility will be converted to a single child care center license under facility number 013423769, therefore LPA will be closing the current preschool facility number 013420547. LPA reviewed with Director the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted. LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Director of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment. Report continues on LIC809-C page 2.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

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 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: TEMPLE SINAI PRESCHOOL	FACILITY NUMBER: 013423769
	VISIT DATE: 01/02/2025

NARRATIVE

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INDOOR ACTIVITY SPACE:
There are two toddler classrooms located in Rooms #208 & #209 and four preschool classrooms located in Rooms #204, #205, #206, & #207. LPA observed a sufficient amount of equipment, toys, tables, chairs, cubbies, and napping cots. There is a first aid kit in each of the classrooms. Medications will be stored above the classroom cabinets. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Director stated there are no poisons or firearms on the premises. Director stated that water bottles are provided to the children through out the day. LPA observed a functional carbon monoxide detector in each classroom. LPA observed an electronic sign-in/sign-out system.

LPA measured the toddler classrooms #208 & #209 and preschool classrooms #204, #205, #206, & #207. The total classroom spaces contain a total of 4,343 square feet, which will accommodate Licensee’s request for 41 toddler and 83 preschool children. There are six toilets/three urinals and thirty sinks for the children, and a separate private restroom for the staff located down the hallway. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the office area and will use the staff restroom, if necessary.

OUTDOOR ACTIVITY SPACE:
There is one outdoor area on the property, Toddler/Preschool Playground. The outdoor play area is fenced with a chain link fence that is at least four feet tall. Director has requested a Shared Outdoor Space Waiver. LPA observed a sufficient amount of equipment and toys. The play structure is designated for children 2 years and above. There are no bodies of water on the premises. There are shaded areas supplied by overhangs and canopies.

LPA measured the outdoor activity space. The outdoor play area contains a total of 5,742 square feet, which will only accommodate 76 children. Director has requested an Insufficient Outdoor Space Waiver. Individual measurements are recorded on the Capacity Worksheet (LIC 9024).

Report continues on LIC809-C page 3.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: TEMPLE SINAI PRESCHOOL	FACILITY NUMBER: 013423769
	VISIT DATE: 01/02/2025

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A 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 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Director any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, 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.

Director was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Report continues on LIC809-C page 4.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: TEMPLE SINAI PRESCHOOL	FACILITY NUMBER: 013423769
	VISIT DATE: 01/02/2025

NARRATIVE

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Written Directives for Lead Testing in Child Care Centers: Assembly Bill 2370, Chapter 676, Statutes of 2018, added Health and Safety Code section 1597.16 requiring all licensed Child Care Centers constructed before January 1, 2010, test their water for lead between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first lead testing. For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Director, Molly Peritore.

The following item is required before a license will be issued:

1. Pending review of Shared & Insufficient Outdoor Space Waiver request.

SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Alecia Sifuentes
LICENSING EVALUATOR SIGNATURE:	DATE: 01/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025

LIC809 (FAS) - (06/04)

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