013418996-8-29-2024-02-CC-MDOY-D8LRRJ-20240829131514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013418996
Report Date: 08/29/2024
Date Signed: 08/29/2024 01:15:48 PM

Document Has Been Signed on 08/29/2024 01:15 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	CONGREGATION NETIVOT SHALOM		FACILITY NUMBER:	013418996
ADMINISTRATOR:	KAREN LLAMAS		FACILITY TYPE:	850
ADDRESS:	1316 UNIVERSITY AVE.		TELEPHONE:	(510) 549-9447
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94702
CAPACITY:	30	CENSUS: 9	DATE:	08/29/2024
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Karen IIamas		TIME COMPLETED:	12:30 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	On Thursday, August 29, 2024 Centralized Application Bureau (CAB) Licensing Program Analyst (LPA) M. Domantay met with Director Karen IIamas for the purpose of a case management inspection. Applicant requests to add a Toddler Program to the existing Preschool license to serve 22 Preschool children from ages 2 years to first grade entry and 8 toddlers ages 18-36 months. The program will operate Monday through Thursday from 8:00 a.m. to 5:30 p.m and Friday 8:00a.m to 4:30p.m. The fire clearance was granted and approved on 12/5/2023, updated request granted on 7/8/2024 from the Berkeley Fire Department. The facility does not provide food, all food is provided from families, from home. 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. INDOOR ACTIVITY SPACE: There are 1 Toddler indoor area: Classroom #2. LPA observed sufficient amount of equipment, toys, tables, and chairs during today's inspection. LPA observed a first aid kit available in main office. Medications will be stored in a top cabinet in the Toddler Classroom. LPA observed cleaning disinfectants are appropriately stored and inaccessible to children. Applicant stated there are no poisons or firearms on the premises. LPA observed a carbon monoxide detector in the facility in Preschool Classroom #1. Per Applicant facility will utilize electronic sign-in/sign-out system. LPA measured the Toddler classroom. The total classroom space contains a total of 330.28 square feet, which will accommodate Applicant's request for 8 Toddler children. There is 1 toilet and 1 sink for the children, and a separate private restroom for the staff is located in the facility. Individual measurements are recorded on the Capacity Worksheet (LIC 9024). Children who become ill during the day will be isolated in the Director's office and will use the staff restroom, if necessary. Page 1

SUPERVISOR'S NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR NAME: Melissa Domantay	TELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CONGREGATION NETIVOT SHALOM	FACILITY NUMBER: 013418996
	VISIT DATE: 08/29/2024

NARRATIVE

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OUTDOOR ACTIVITY SPACE:
There is 1 outdoor area at the facility, the Preschool outdoor play yard. The outdoor play area is fenced with wooden fencing that is at least four feet tall. There is no play structure in the play yard. Play yard has mats as cushioning to cushion a child's fall. LPA observed a sufficient amount of equipment and toys. There are no bodies of water on the premises. LPA reminded Director to ensure to empty all water tables when not in use. There is sufficient shading areas provided by trees, canopies, and wooden awning in the play yard.

All measurements remain the same for the outdoor activity space from previous pre-licensing inspections.

LPA notified Director must submit a waiver request for Toddler children to share the yard with the preschool program with a set rotation schedule in place. LPA notified Director that LPA will review play yard photos with Licensing Program Manager (LPM) Mai Lor if preschool yard is age appropriate for Toddlers to utilize.

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

LPA discussed the following: 100% supervision is required at all times, including in the bathroom; personal rights; inspection authority; reporting requirements; staff to children ratios and capacity; staff qualifications; and maintaining buildings and grounds. LPA discussed with Applicant any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within 10 working days.

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SUPERVISOR'S NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR NAME: Melissa Domantay	TELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CONGREGATION NETIVOT SHALOM	FACILITY NUMBER: 013418996
	VISIT DATE: 08/29/2024

NARRATIVE

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Applicant was reminded that all adults 18 and over responsible for administration or 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 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.

Applicant was informed of the MyChildCarePlan.org site, 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.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with the Director, Karen IIamas.

The following items are required before a license will be issued:

1. Licensing Program Manager (LPM) final file review.

2. Applicant must submit revised, updated LIC200A.
3. Applicant must submit a waiver request for Toddler children to share the yard with the preschool program with a set rotation schedule in place.
4. Applicant must submit Toddler staff job description

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SUPERVISOR'S NAME: Mai Lor	TELEPHONE: (916) 491-0182
LICENSING EVALUATOR NAME: Melissa Domantay	TELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC809 (FAS) - (06/04)

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