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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 384004702
Report Date: 07/16/2024
Date Signed: 07/16/2024 01:17:28 PM

Document Has Been Signed on 07/16/2024 01:17 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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:SHERITH ISRAEL PRESCHOOLFACILITY NUMBER:
384004702
ADMINISTRATOR/
DIRECTOR:		HOLTON, COURTNEYFACILITY TYPE:
850
ADDRESS:2266 CALIFORNIA STREETTELEPHONE:
(415) 346-1720
CITY:SAN FRANCISCOSTATE: CAZIP CODE:
94115
CAPACITY: 75TOTAL ENROLLED CHILDREN: 7CENSUS: 7DATE:
07/16/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Director, Courtney HoltonTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 7/16/2024, at approximately 9:00AM, Licensing Program Analyst (LPA) Jonathan Tse conducted an unannounced annual visit at the facility. LPA met with Director, Courtney Holton (D1), and explained the purpose of the visit. Present during the visit was D1, two staff members, and seven preschool age children. The facility is in compliance with staffing and ratio requirements on this day. The facility’s operating hours are from 8:30AM to 5:30PM.

LPA and D1 inspected the facility for any health or safety hazards. The facility is equipped with an operational carbon monoxide detector. There are fully charged 2A10BC fire extinguishers present throughout the facility. Emergency exit routes are posted and accessible for review. Emergency exits are clearly marked and visible. Poisons, cleaning detergents, and other chemicals are stored inaccessible to children in care.

The facility typically provides care in three classrooms: Sprouts, Willows, and Sages. The facility is currently providing care for children in the Sprouts classroom for summer session. LPA observed all classrooms to be equipped with age-appropriate toys and learning materials. Furniture was observed to be age-appropriate and free of rough or sharp edges. Per D1, the facility provides mats for children to nap on. Bedding is also provided and cleaned by the facility as needed. Children bring lunch from home and the facility provides AM/PM snacks. Children bring water bottles from home and the facility refills them as needed using filters. There are first aid kits in each classroom that were observed to be complete. Waste bins were fitted with tight-fitting lids.

The facility does not have an outdoor space on its premises. There are no pools or other similar bodies of water. The facility has a waiver that allows for the use of Lafayette Park, which is a nearby park that is within walkable distance for children in care. LPA discussed the terms and conditions of the waiver with D1 during the visit. Children were under direct visual supervision of a staff member. Water is available for children in care. There is shade available for children, and play structures were observed to be age appropriate.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
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 07/16/2024 01:17 PM - It Cannot Be Edited


Created By: Jonathan Tse On 07/16/2024 at 12:19 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
, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: SHERITH ISRAEL PRESCHOOL
FACILITY NUMBER: 384004702

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is 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.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by not testing fixtures for lead before 1/1/2023 which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/16/2024
Plan of Correction
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Licensee has tested the facility's fixtures for lead on 6/29/2024. This deficiency shall be cleared once lead testing results are posted and available for review on the lead sampling database.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Ali Zebila
LICENSING EVALUATOR NAME:Jonathan Tse
LICENSING EVALUATOR SIGNATURE:
DATE: 07/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/16/2024


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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SHERITH ISRAEL PRESCHOOL
FACILITY NUMBER: 384004702
VISIT DATE: 07/16/2024
NARRATIVE
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LPA reviewed three staff files, five children’s files, and facility records. There is at least one staff member with current Pediatric First Aid/CPR. Staff members have completed Mandated Reporter Training. LPA observed children’s files to contain Emergency Identification and Information (LIC700), Consent for Emergency Medical Treatment (LIC627), and update immunization records. LPA advised that Physicians’ Reports (LIC701) shall be signed by a physician. D1 stated that they understood.

The facility had its fixtures sampled for lead on 6/29/2024. This is past the deadline of 1/1/2023. Lead testing requirements were discussed with D1. D1 was informed that a Type B citation would be issued due to lead testing being conducted past the deadline. D1 stated that they understood.

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.

Facility representative was reminded that all adults 18 and over, 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.

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).

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.
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SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
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 CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: SHERITH ISRAEL PRESCHOOL
FACILITY NUMBER: 384004702
VISIT DATE: 07/16/2024
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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated 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 are available at: https://www.ada.gov/resources/child-care-centers/.

Facility representative was informed of the MyChildCarePlan.org website; 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.

See LIC809-D for deficiency cited today regarding lead water testing. LPA requested that D1 submit copies of forms LIC999, 9275, and 9276 via email.

See LIC9102-TV for technical violation issued today regarding Physician’s Reports.

See LIC9102-TA for technical assistance provided today regarding the facility’s outdoor waiver.

Appeal rights were provided and explained. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Courtney Holton.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Jonathan Tse
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2024
LIC809 (FAS) - (06/04)
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