Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490102569
Report Date: 09/28/2017
Date Signed: 09/29/2017 12:25:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:GAN ISRAEL PRESCHOOLFACILITY NUMBER:
490102569
ADMINISTRATOR:LAURITZEN, LESLEEFACILITY TYPE:
850
ADDRESS:740 WESTERN AVENUETELEPHONE:
(707) 763-5136
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:24CENSUS: 22DATE:
09/28/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Leslee Lauritzen, DirectorTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) N.Cunningham conducted an unannounced annual/random inspection. During today's visit, LPA met with Director Leslee Lauritzen. During today's visit, there were 22 preschoolers in care with 2 Teachers. All staffs working in the facility are fingerprint cleared. Ratio/Capacity was met.

LPA inspected the facility indoor and outdoor. The Director stated that there are no weapons, poisons or bodies of water in the facility and none were observed. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. There is a functional carbon monoxide detector in the facility. There are 7 toilets and 5 sinks in the facility. All toilets, hand washing stations were sanitary and in good operating condition. All floors were clean and sanitary. All kitchen food preparation, storage areas is clean and free of litter, rubbish and free of rodents and other vermin. All foods or beverages capable of supporting the rapid and progressive growth of micro-organisms that can cause food intoxication were stored in covered containers at 45 degrees F (7.2 degrees C) or less. The facility was free of flies, other insects and rodents. There is a fully charged fire extinguisher that was recently serviced. Fire drill are conducted and documented monthly. All required postings were posted. The sign in/sign out sheet is complete, with parents full signatures. There is at least one person with CPR/First Aid, which expires on 8/2019. There is a First Aid kit in the facility. There is a weekly snack menu posted. The facility has a current facility roster of children in the facility. The Playground was inspected and the playground is free of hazards. The playground has age appropriate toys. The playground has a fence that is at least 4 feet in height. The playground has sufficient shade. Staff and children's files were reviewed and found to be in compliance.

see 809C
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: 707-588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2017
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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: GAN ISRAEL PRESCHOOL
FACILITY NUMBER: 490102569
VISIT DATE: 09/28/2017
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This facility is not currently providing Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (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 provided information on a child's care provider's Guide to Safe Sleep and Health and Safety 1596.7995 handout.

All licensing reports are public information and must be made available upon request.


Notice of Site Visit shall be posted for 30 days from today's date.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: 707-588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2017
LIC809 (FAS) - (06/04)
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