214005617-3-6-2025-05-CC-NGAA-DEJ242-20250306160314

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 214005617
Report Date: 03/06/2025
Date Signed: 03/06/2025 04:04:13 PM

Document Has Been Signed on 03/06/2025 04:04 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
SAN BRUNO CHILD CARE, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME:	GROVE PRESCHOOL AT KOL SHOFAR, THE		FACILITY NUMBER:	214005617
ADMINISTRATOR/ DIRECTOR:	BARBONI, KATHERINE		FACILITY TYPE:	850
ADDRESS:	215 BLACKFIELD DRIVE		TELEPHONE:	(415) 388-1818
CITY:	TIBURON	STATE: CA	ZIP CODE:	94920
CAPACITY: 105	TOTAL ENROLLED CHILDREN: 105	CENSUS: 53	DATE:	03/06/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:59 PM
MET WITH:	Katherine Barboni		TIME VISIT/ INSPECTION COMPLETED:	04:20 PM

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On March 6, 2025, Licensing Program Analyst (LPA) Nathan Garcia arrived at the facility and met with director, Katherine Barboni for an unannounced annual/random inspection of the preschool licensed facility. Purpose of the inspection was explained. There were 53 total children 4 of those children are under 2 years old for their toddler component. There were a total of 14 teachers, including the director. Facility operates day care program Monday-Friday, 8:00-5:00pm.

LPA inspected day care rooms, and the outdoor space. LPA observed facility has combined smoke/fire and carbon monoxide detector, multiple fully charged fire extinguisher model 3A40BC located in the classrooms. LPA tested the functionality of the carbon monoxide detectors. All cleaning solutions, poisons, and other chemicals dangerous to the children are stored inaccessible to the children. Facility has age-appropriate furniture. Facility floor and rugs are in good repair and free of any hazards.

There are first aid supplies available in the classroom. The bathroom is in working condition, for the toilets and sinks. Individual items provided by the parents are labeled and stored appropriately. Per Katherine, the facility provides water through filtered faucets, refilled as needed. All food is stored properly to avoid contamination. The parents provides all snacks and lunches from home. LPA observed that there are a variety toys/books for the children to use.

LPA observed outdoor areas has age appropriate play structures are free from health and safety hazards. The outdoor area has shaded areas for the children to rest. The outdoor areas slides, climbing structures on wood chips. LPA observed there are multiple toys and children's push carts, bikes, scooters to ride on. LPA observed the playhouses, sand box and play things are in good repair. There's also a garden and sheds/bins and storage areas for the toys when they're not being used. The play area for the toddlers was also observed to be in good repair. According to Katherine, the playground for the preschoolers will be going under renovation, no changes in square footage, just an upgrade. The renovation will start in May until their last day of school in June. The preschoolers will be utilizing the yard and the garden during the construction.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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

FACILITY NAME: GROVE PRESCHOOL AT KOL SHOFAR, THE	FACILITY NUMBER: 214005617
	VISIT DATE: 03/06/2025

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CCC COMPLETED TESTING AND LEAD EXCEEDANCES WERE REMEDIATED:

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).

Based on record review, the facility completed the lead water testing on August 17, 2022. The exceedances were immediately remediated and the facility retested without any exceeded levels.

According to staff, the facility is using Brightwheel app for sign in/out. Facility has license and all other required documents posted and visible for the public. Facility completed their most recent emergency drill on 2/12/25. Per staff, drills are done at least every 6 months rotating them between fire and earthquake drills. LPA observed that one of the classrooms changed names from Etzim to Keshet. The facility's toddler classroom is currently the Rimonim classroom.

LPA reviewed the facility records. LPA reviewed 6 child's file during the visit. LPA reviewed 4 staff files with qualifying requirements such as ECE Units and Mandated Reporter Training.

The Director was reminded that all adults 18 and over, 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.

Facility was informed that as of September 1, 2016, a person may not be employed or volunteer at a childcare facility unless he or she has been immunized against influenza, pertussis, and measles or qualifies for an exemption pursuant to Health and Safety code 1596.7995 and 1597.662.

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SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

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

FACILITY NAME: GROVE PRESCHOOL AT KOL SHOFAR, THE	FACILITY NUMBER: 214005617
	VISIT DATE: 03/06/2025

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Director is aware that all staff is required to complete Mandated Reporter Training every two years. The training can be obtained online at www.mandatedreporterca.com. LPA observed the completion certificates on file.
LPA encourages the director to frequently visit our website at www.ccld.ca.gov for licensing regulations and new updates.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

LPA verified that all medications are valid.
Incidental Medical Services – IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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

Director was advised any additional questions to call Office, M-F, 8am-5pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov

No deficiencies issued under Title 22 Regulations during the inspection.

A copy of this report was given with the “Notice of Site Visit” to the staff. A Notice of Site Visit must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed and signed by Director, Katherine Barboni.

LPA will email the report to director due to printer malfunction and confirmation of receipt is required.

SUPERVISORS NAME: Daniel J Oquendo
LICENSING EVALUATOR NAME: Nathan Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025

LIC809 (FAS) - (06/04)

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