414005215-8-8-2025-05-CC-AMEN-DKCT8V-20250808143055

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 414005215
Report Date: 08/08/2025
Date Signed: 08/08/2025 02:32:42 PM

Document Has Been Signed on 08/08/2025 02:32 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:	PENINSULA TEMPLE SHOLOM		FACILITY NUMBER:	414005215
ADMINISTRATOR/ DIRECTOR:	ALLISON STECKLEY		FACILITY TYPE:	860
ADDRESS:	1655 SEBASTIAN DRIVE		TELEPHONE:	(650) 697-2279
CITY:	BURLINGAME	STATE: CA	ZIP CODE:	94010
CAPACITY: 164	TOTAL ENROLLED CHILDREN: 164	CENSUS:	DATE:	08/08/2025
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:45 AM
MET WITH:	Allison Steckley		TIME VISIT/ INSPECTION COMPLETED:	02:45 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	Licensing Program Analysts (LPAs) Andrea Medlin and Catrina Quimbo met with applicant, Allison Steckley. Purpose of visit was explained. LPAs conducted a pre-licensing inspection at facility to ensure that health, safety and personal rights as required by Title 22 and Health and Safety Regulations governing California Child Care Centers will be met. This is an application for a total capacity of 164 children: 8 infants, ages 6 months to 18 months; 12 toddlers ages 18 months to 36 months; and 144 preschool ages 2 years to 5 years old. Program is an already licensed preschool program under license number 410509197. This is a single license conversion. Infant and toddler program will operate Monday - Friday 8:30AM-5:30PM. Preschool program will operate Monday - Friday 8:00AM-6:00PM. Fire inspection was conducted on 7/29/2025 by Central County Fire Department. This is a single license conversion. LPAs toured and measured the on-limits areas and classrooms located at the facility. The facility has a total of 11 classrooms: 1 infant classroom (room #11), 1 toddler classroom (room #10) and 9 preschool classrooms (rooms #1-9). Children will have access to a total of 23 sinks, 10 toilets, 2 urinals, and 4 changing tables. Classroom measurements are: The Indoor total measurements contain a total of 6,287.79 square feet, which will accommodate applicant's request for 164 children. Applicant is requesting to care for 8 Infants, 12 Toddlers and 144 Preschool. Outdoor Play measurements are: Outdoor total measurements contain a total of 12,103. 62 square feet, which will not accommodate applicant’s request for 164 children. Applicant will submit an outdoor activity space waiver. (Continued on next page LIC-809-C)

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: PENINSULA TEMPLE SHOLOM	FACILITY NUMBER: 414005215
	VISIT DATE: 08/08/2025

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Indoor/Children’s Area:

Indoor activity space for infants shall be physically separate from space used by preschool children components.

All outdoor and indoor passageways and other areas of potential hazard were observed to be free of obstruction. The child care center was observed to be clean, safe, sanitary and in good repair. The facility is equipped with central heating and air-conditioning to provide and maintain a comfortable temperature for children at all times. The infant care center is equipped with appropriate furniture and equipment including, 4 cribs, 1 changing table and 6 feeding chairs. Tables and chairs were observed to meet the needs of the children. Furniture is in good repair and safe condition.

The type, height and size of furniture and equipment are age appropriate. Toys were observed to be safe without sharp points or edges or splinters, LPAs observed that each child has an individual permanent storage space for his/her clothing, personal belongings and/or bedding. All materials and surfaces accessible to children, including toys, were observed to be free of toxic substances.

Drinking water from a non-contaminating fixture or container shall be readily available both indoors and in the outdoor activity area. LPAs advised per Health and Safety Code 1597.16(a)(1) Lead Testing and PIN-21-21-CCP Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010 to test their drinking water for lead contamination between January 1, 2020 and January 1, 2023, and then every 5 years after the date of the first test. Per Written Directive 100700(c)(1) Written Directives for Lead Testing (1) For a license issued on or after July 1, 2022, initial testing results shall be received and posted within 180 days of licensure.

The applicant shall take measures to keep the center free of flies, other insects, and rodents. All containers used for storage of solid wastes, including moveable bins, were observed with tight fitting lids. There are no fireplaces and open-faced heaters located inside the facility. All window screens are in good repair and free of insects, dirt and debris.

(Continued on next page 809-C)

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

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

FACILITY NAME: PENINSULA TEMPLE SHOLOM	FACILITY NUMBER: 414005215
	VISIT DATE: 08/08/2025

NARRATIVE

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Disinfectants, cleaning solutions, poisons and other items that could pose a danger if readily available to children are stored inside a locked cabinet located in each classroom. First-aid supplies - sterile first-aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometer, and antiseptic solution - are available and accessible to staff. Smoking is prohibited on facility premises as specified in Health and Safety Code Section 1596.795(b).

Isolation area for ill children shall be in the facility's main office who becomes ill during the day and shall be under visual supervision at all times. LPAs observed and tested multiple operable carbon monoxide detectors located throughout facility. Facility has working telephone service on the premises. Sign-in and out is located at the facility entrance. The applicant shall be responsible for ensuring that children with obvious symptoms of illness including - but not limited to - fever or vomiting, are not accepted.

LPAs advised applicant of licensing requirement of 35 square feet per child for indoor space; one toilet and hand washing fixture requirement for every 15 children.

Napping:

LPAs observed 4 standard cribs that meet regulations. Crib mattresses shall be in accordance with the manufacturers instructions for use. Cots shall comply with Section 101239.1(b) licensing requirements. Infants shall be transitioned to cots who demonstrate ability to climb out of the crib. The calculation of indoor activity space excludes infants sleeping area and placement of crib locations. Cots used for napping shall be maintained in a safe condition and a surface material that can be disinfected and cleaned.

Applicant provides a variety of age-appropriate equipment, toys and materials are observed to be in sufficient quantity for children and in good condition to participate in planned activities.

LPA observed changing tables with a padded surface no less than one-inch thick and covered with washable vinyl or plastic having raised sides at least three inches high, be maintained in good repair and safe condition. While in use, be placed within arm's reach of a sink. Not be located in the kitchen/food-preparation area.

(Continued on next page 809-C)

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

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

FACILITY NAME: PENINSULA TEMPLE SHOLOM	FACILITY NUMBER: 414005215
	VISIT DATE: 08/08/2025

NARRATIVE

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Restrooms:

There is a shared children's restroom. LPA observed all toilets and hand washing sinks to be in safe and sanitary operating condition. Sinks were observed to disperse cold water for hand washing.

Outdoor:

Outdoor activity spaces were observed to be physically separate from space used by children in the different age components. LPAs observed shaded rest areas for children to be free of hazards including holes, broken glass, and other debris. The outside areas around and under high climbing equipment, swings, slides and other similar equipment were observed to be cushioned with material that absorbs falls. The playground was observed to be enclosed and meet regulation requirement of at least four feet to protect children while maintaining them in designated area. Any construction or equipment that could pose a hazard in the outdoor activity area shall be maintained and inaccessible to children. No swimming pools, hot tubs, or similar bodies of water were observed.

Health Related Services:

Medications are stored in each classroom located in classrooms' high shelves. Some medication that is not immediate is also stored in the facility's main office. Applicant has developed and implemented a written plan to record the administration of prescription and nonprescription medications and to daily inform the child's representative when medication is administered.

Food Service:

Per applicant, parents will provide all food. Staff will complete an infant needs and services plan prior to enrollment. For infants, all bottles, dishes, and food containers brought from home shall be labeled with name and date. There is a refrigerator in each classroom, if needed.

(Continued on next page 809-C)

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

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

FACILITY NAME: PENINSULA TEMPLE SHOLOM	FACILITY NUMBER: 414005215
	VISIT DATE: 08/08/2025

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Pesticides and other similar toxic substances shall not be stored in food-preparation areas, or areas where kitchen equipment or utensils are stored. Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. Food-preparation and storage areas were observed to be clean and free of litter and rubbish, measures shall be taken to keep all such areas free of rodents and other vermin.

LPA observed the following postings in a prominent, publicly accessible location in the center. LIC 613A(9/96), PUB 393 (8/02), Child Care Center Notification of Parents' Rights and LIC 610 Disaster Plan. The license shall be posted when received; applicant reminded of the requirements to ensure license number is included in all advertisements in accordance with Health and Safety Code Section 1596.861.

Applicant was reminded that all adults 18 and over responsible for administration, 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 of5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if in violation.

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.

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.

(Continued on next page 809-C)

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

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

FACILITY NAME: PENINSULA TEMPLE SHOLOM	FACILITY NUMBER: 414005215
	VISIT DATE: 08/08/2025

NARRATIVE

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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.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helpsfamilies obtain child care by connecting them to child care providers and Resource and ReferralAgencies (R&Rs) throughout California. Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers,and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update News letters and other important information communication platforms.To receive important licensed related information to licensed facilities, visit the CCLD ImportantInformation website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The following corrections are needed before licensure will be considered. Corrections are due by August 29, 2025:

Working sink in Toddler classroom.
Fire clearance on licensing form (STD850).
Final set up of all preschool classrooms.
Submission and approval of outdoor rotation waivers.

Final licensure approval will be determined by review by the Centralized Application Bureau (CAB) Licensing Program Manager.

Exit interview conducted and reviewed with facility representative, Allison Steckley, and a copy of this report must be made available for public review upon request.

NAME OF LICENSING PROGRAM MANAGER: Deborah Lowe
NAME OF LICENSING PROGRAM ANALYST: Andrea Medlin
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025

LIC809 (FAS) - (06/04)

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