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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002930
Report Date: 11/04/2021
Date Signed: 11/05/2021 01:29:06 PM

Document Has Been Signed on 11/05/2021 01:29 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:NEWTON @ ENCINALFACILITY NUMBER:
414002930
ADMINISTRATOR:DOMINIQUE JOHNSONFACILITY TYPE:
840
ADDRESS:195 ENCINAL AVENUETELEPHONE:
(650) 274-9913
CITY:ATHERTONSTATE: CAZIP CODE:
94027
CAPACITY: 120TOTAL ENROLLED CHILDREN: 92CENSUS: 68DATE:
11/04/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Edy RodriguezTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Glenn Schnell conducted a case management inspection in response to a written request received via email on 11/1/21 from licensee Tal Tamir. The request is to add three additional rooms to the license; Rooms 8, 33, and the large multi-purpose room. The program, being a school age program and operating on a functioning school site, is exempt from meeting square footage requirements for indoor/outdoor space and the sink/toilet to child ratio requirements.

LPA Schnell inspected the facility today including the existing approved rooms as well as the rooms requesting to be used. LPA reviewed an updated campus map and the most current elementary school fire clearance (2020) that Tal obtained from the school district.

The following rooms are approved for use effective today; 1-4, 8, 9, 11, 13B, 17, 24A, 27, 28, 33, library, staff lounge, small and large multi-purpose rooms, school stage.

Fingerprint clearances for staff working and associated to this location were verified today. Clearances are centrally associated to another Newton facility location (Newton-Baywood, license 414001240).
Covid-19 protocols were reviewed/discussed today.
Licensee was reminded to stay current on all updates to policies, procedures and licensing regulations. Information can be obtained at www.ccld.ca.gov
LPA is requesting that a site supervisor packet be submitted for the designated site supervisor Edy Rodriguez. LPA provided Edy Rodriguez with a list of required documents.

No deficiencies cited today.
SUPERVISORS NAME: Ali Zebila
LICENSING EVALUATOR NAME: Glenn A Schnell
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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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