214005617-7-29-2022-05-CC-CQUO-CGST7T-20220729142912

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005617
Report Date: 07/29/2022
Date Signed: 07/29/2022 02:29:59 PM

Document Has Been Signed on 07/29/2022 02:29 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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	GROVE PRESCHOOL AT KOL SHOFAR, THE		FACILITY NUMBER:	214005617
ADMINISTRATOR:	BARBONI, KATHERINE		FACILITY TYPE:	850
ADDRESS:	215 BLACKFIELD DRIVE		TELEPHONE:	(415) 388-1818
CITY:	TIBURON	STATE: CA	ZIP CODE:	94920
CAPACITY: 70	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	07/29/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Katherine Barboni		TIME COMPLETED:	02:30 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	On July 29, 2022 at approximately 9:45am, Licensing Program Analyst (LPA) Catrina Quimbo conducted an announced, pre-licensing inspection. LPA met with applicant, Katherine Barboni, and explained the purpose of the inspection. The applicant is requesting for a preschool license with a toddler option. The applicant is requesting for a capacity of 60 preschool children (2 years to 5 years) and 10 toddler children (18 months to 36 months). Applicant is aware children in toddler program are not to enter the preschool program without written permission from the child's authorized representative. The facility will operate Monday through Friday from 8:30am to 5:30pm. Children will be signed in and out of the facility with parents' electronic signatures. Applicant is aware sign in/out records must be made readily available for review during a future inspection. The facility was inspected indoors and outdoors for health and safety hazards and measured to calculate capacity. Indoors: There are 5 classrooms that will be used for the licensed capacity; 3 classrooms for preschool program and 2 classrooms for toddler program. The preschool classrooms include Zetim, Tamarim, and Etzim. The toddler program classrooms include the Anavim and Rimonim. The Zetim classroom was measured for 1,094.56 sq ft. allowing for a capacity of 31 children. The Tamarim classroom was measured for 812.26 sq ft allowing for a capacity of 23 children. The Etzim classroom was measured for 700 sq ft allowing for a capacity of 20 children. The Anavim classroom was measured for 760.16 sq ft. allowing for a capacity of 21 children. The Rimonim classroom was measured for 812.26 sq ft. allowing for a capacity of 23 children. Total allowable capacity was calculated for 4,017.96 sq ft. allowing for an overall capacity of 114 children. (Continue on Page 2...)

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GROVE PRESCHOOL AT KOL SHOFAR, THE	FACILITY NUMBER: 214005617
	VISIT DATE: 07/29/2022

NARRATIVE

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Each classroom was observed to be clean, equipped with a fully charged fire extinguisher, carbon monoxide detector, and fully stocked First Aid Kit. Overall facility maintains a fire alarm system. All furnishings, toys and equipment was observed to be safe, age appropriate and in good condition. Sufficient storage space for children's personal belongings are located inside each classroom. Mats will be utilized for napping children. Children's authorized representatives will provide sheets that will be sent home weekly for laundering.

Entire facility is adequately ventilated and free of insects and bugs. Cleaning products will be stored in each classroom's high cabinets and/or locked behind child safety, locked cabinets. Each classroom also includes 1 children's sink and 1 adult sink. All sinks accessible to children do not provide water that is warmer than 120 degrees Fahrenheit.

The facility also includes 6 multi-purpose areas: Light and Shadow Room, Cooking area, Beit Am gathering center, Kitah 1, Kitah 2, and Kitah 3. Due to the space not being used as a daily classroom and used as multi-purpose areas, the space is not included or measured for overall square footage/ capacity. The facility also includes 2 offices for the director and assistant director, as well as a staff lounge. Isolation area for sick children is located inside the staff lounge.

Preschool bathroom (located next to Zetim classroom) includes 3 toilets and 3 sinks, allowing for a capacity of 45 children. Second preschool bathroom (located next to cooking area) includes 2 toilets and 2 sinks, allowing for a capacity of 30 children. The toddler bathroom includes 1 toilet, 1 sink and 1 changing table, allowing for a capacity of 15 children. The facility also has an additional bathroom for children's use, located near director's office that includes 1 toilet and 1 sink, allowing for a capacity of 15 children. Total allowable capacity for sinks and toilets is 105 children.

Program will provide a food service that includes morning and afternoon snacks and lunch Wednesdays through Fridays. Children are to provide their own lunch Mondays and Tuesdays. LPA reminded applicant children who bring their own items are to be labeled with each child's individual names. Facility will require children to provide their own individually, labeled water containers that will be refilled at the facility. Water is available to children both indoors and outdoors with accessible water fountains.

LPA reminded applicant to conduct and document emergency disaster drills at least one every six months.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GROVE PRESCHOOL AT KOL SHOFAR, THE	FACILITY NUMBER: 214005617
	VISIT DATE: 07/29/2022

NARRATIVE

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Medications with children’s individual names and required documentation will be stored in classroom’s high cabinets in off limit area. Medications that require refrigeration will be stored in cooking area's refrigerator. This facility plans to provide Incidental Medical Services –IMS. For IMS information, see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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.

Outdoor: The outdoor area includes 2 separate playgrounds: 1 for the preschool program and 1 for the toddler program. The preschool outdoor area measures for 5,890.94 sq ft. allowing for a capacity of 78 children. The toddler outdoor area measures for 3,091.27 sq ft. allowing for a capacity of 41 children. Entire outdoor area is enclosed with an at least 4 ft. high fence. Outdoor areas were observed to be clean. Adequate shade is provided by trees and building in surrounding area as well as designated areas with tarp. Play structures were observed to clean with resilient padding underneath. Water is made available with accessible drinking fountains.

Applicant 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, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant 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 applicant 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.

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SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

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, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: GROVE PRESCHOOL AT KOL SHOFAR, THE	FACILITY NUMBER: 214005617
	VISIT DATE: 07/29/2022

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LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

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.

From applicant, LPA was provided with:
-Updated Memorandum of Understanding
-Updated Personnel Report
-Updated Emergency Disaster Plan
-Board Resolution Meetin
-Copy of required immunizations for applicant
-Sample copy of program's food menu
-IMS plan

Based on LPA's measurements from today's inspection, maximum capacity facility can be licensed for is 105 children.

Prior to recommended licensure for 105 children, following must be completed:
-Fire clearance.
-Full review by LPA.

Exit interview conducted and report was reviewed with the applicant, Katherine Barboni.

SUPERVISORS NAME: Cindy Interiano
LICENSING EVALUATOR NAME: Catrina Quimbo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2022

LIC809 (FAS) - (06/04)

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