434404443-5-22-2024-07-CC-SYIP-D5HSAK-20240522134225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 434404443
Report Date: 05/22/2024
Date Signed: 05/22/2024 01:42:30 PM

Document Has Been Signed on 05/22/2024 01:42 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME:	TEMPLE EMANU-EL PRESCHOOL		FACILITY NUMBER:	434404443
ADMINISTRATOR/ DIRECTOR:	SMEAD, BARBARA		FACILITY TYPE:	850
ADDRESS:	1010 UNIVERSITY AVENUE		TELEPHONE:	(408) 293-8660
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95126
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 90	CENSUS: 74	DATE:	05/22/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:51 AM
MET WITH:	Kira Umeki		TIME VISIT/ INSPECTION COMPLETED:	01:15 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 Analyst (LPA) Samantha Yip conducted an unannounced Annual/Random inspection. LPA met with Assistant Director Kira Umeki and explained the reason for the inspection. There is a waiver to use the Sanctuary and Patio at the Temple Emanu-El. There is an area to post required postings, such as license, notification of parent's rights, and personal rights. There is a working phone. The hours of operation are Monday through Friday 7AM to 6PM. LPA reviewed the sign in/sign out sheet. LPA toured the inside and outside of the center with Assistant Director Kira. Disinfectant, cleaning supplies, and other items that could pose a risk to children were observed to be inaccessible to children. There are toys and equipment for children. There is a fully charged fire extinguisher and smoke detector. The fire/disaster drill was conducted on 04/19/2024. Assistant director stated that there are no weapons, such as firearms, stored on the premise. The outside area is fenced. Area around play structure have resilient material, tan bark, but it is low. Shaded rest area is provided through canopy and building overhang. There were no bodies of water observed during today's inspection. All meals are prepared and brought from home. The center only provides snacks to children, which are all pre-packaged food. Menu was observed to posted. Drinking water is provided through individual water bottles, water fountain, and water cooler. ------------------continues on 809 dated 05/22/2024 page 2-----------------------

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TEMPLE EMANU-EL PRESCHOOL	FACILITY NUMBER: 434404443
	VISIT DATE: 05/22/2024

NARRATIVE

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-------------------continuation of 809 dated 05/22/2024 page 1-------------------

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and
administrative records. For IMS information see PIN 22-02-CCP. 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/.

All staff present have cleared fingerprints. 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.

Center will submit the following by 05/31/2024:
- Plan for Providing Incidental Medical Services

Assistant Director was informed that inspection will need to continue at a later date.

As a result of inspection, a Type B citation was issued. Exit interview conducted and report was reviewed with Assistant Director Kira Umeki. A notice of site visit has been issued and must remain posted for 30 days.

SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Samantha Yip
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/22/2024 01:42 PM - It Cannot Be Edited

Created By: Samantha Yip On 05/22/2024 at 12:58 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
, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: TEMPLE EMANU-EL PRESCHOOL	FACILITY NUMBER: 434404443
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type B

Section Cited

CCR

101238.2(e)

Outdoor Activity Space

(e) As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. There is tan bark around the play structure; however, it is low.
	POC Due Date: 05/31/2024
	Plan of Correction
1 2 3 4	By POC 05/31/2024, the center will submit proof that additional tan bark was purchased or that there is sufficient amount of tan bark below the play structure.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Joel Segura

LICENSING EVALUATOR NAME:

Samantha Yip

LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC809 (FAS) - (06/04)

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