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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412177
Report Date: 11/06/2023
Date Signed: 11/06/2023 11:40:05 AM


Document Has Been Signed on 11/06/2023 11:40 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612



FACILITY NAME:CLUB J AT THE OSHMAN FAMILY JCCFACILITY NUMBER:
434412177
ADMINISTRATOR:MALLARE, CYRUSFACILITY TYPE:
840
ADDRESS:3921 FABIAN WAYTELEPHONE:
(650) 223-8625
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:192CENSUS: 0DATE:
11/06/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Director Cyrus Mallare- Diethorn and Senior Director, Dave Rosenfeld TIME COMPLETED:
11:45 AM
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On November 6 ,2023 Licensing Program Manager (LPM) Wynn Norona and Licensing Program Analyst (LPA) Jyoti Saini and ( LPA) Michael Mathew met with Director Cyrus Mallare- Diethorn and Senior Director, Dave Rosenfeld for an informal meeting at the Oakland South Childcare Regional Office. The purpose of the meeting was to discuss the lack of care and supervision where a child was left unattended by a staff member in the school van.

The incident was reported to Community Care Licensing Division (CCLD) on September 6, 2023.

The facility has already submitted an action plan to prevent such incidents in the future. Per facility, the educators will perform a face-to-name check of all children and visually inspect the van, front to back and row by row, to ensure no child has been left behind. In addition, the educators will accompany all children to the sign-out table to confirm their presence with another face-to-name check in coordination with the Club J staff members signing the children in. Furthermore, the facility will conduct program-wide attendance checks through the ProCare Connect system. The facility also held an all-staff meeting regarding Supervision on September 18, 2023, to ensure that all staff members are thoroughly trained on the new procedures.

Director Cyrus Mallare-Diethorn provided proof of complete training on the sign-in/out and transitions check with staff on September 18, 2023.

An exit interview was conducted, and the report was reviewed with Director, Cyrus Mallare- Diethorn, and Senior Director, Dave Rosenfeld.

SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jyoti SainiTELEPHONE: 510-298-7052
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2023
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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