Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313616885
Report Date: 05/21/2019
Date Signed: 05/22/2019 07:54:20 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:GAN YELADIM JEWISH PRESCHOOLFACILITY NUMBER:
313616885
ADMINISTRATOR:KORIK, MALKAFACILITY TYPE:
850
ADDRESS:4410 DOUGLAS BLVD.TELEPHONE:
(916) 500-4522
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:30CENSUS: DATE:
05/21/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Malka KorikTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analysts (LPA) Jeremey McClain and Karyn Guerra met with Director Malka Korik for an unannounced Licensee Case Management Inspection.

Upon arrival, LPA observed six preschool children playing in a playground that has not been approved for use by licensing. The children were being supervised by two staff members. There were also school age children playing on the cement area to the right of the play structure. LPAs spoke to Isroel Korik about the structure, who then moved the children to a licensed area.

The Director understands that the play area must be approved by licensing before children in care may use it.

This is a violation of Title 22 Regulations and if not addressed, can potentially be harmful to children. Deficiencies are noted on the 809-D page of this report.


This report was reviewed with the licensee. LPA provided a Notice of Site Visit, which must remain posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: GAN YELADIM JEWISH PRESCHOOL
FACILITY NUMBER: 313616885
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/24/2019
Section Cited
CCR
101237(a)
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Alterations to Existing Buildings or New Facilities. (a) Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s). This requirement was not met as evidenced by
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Director stated that she will create a statement that states day care children will not be allowed to use the unlicensed play structure. Director stated that she will consider getting the area licensed but children will not be allowed to use the playground before doing so.
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LPAs observation of six preschool children playing on a playground that has not been approved by licensing. This is a potential risk to the health and safety of children in care.
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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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
LIC809 (FAS) - (06/04)
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