Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490102569
Report Date: 04/03/2019
Date Signed: 04/03/2019 11:03:12 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
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:35CENSUS: 26DATE:
04/03/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Leslee LauritzenTIME COMPLETED:
11:15 AM
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At 9:10 am on 04/02/2019, an unannounced inspection was made to the facility by Licensing Program Analyst (LPA), Jen Velasco. The facility file was reviewed prior to this visit. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

The facility’s operating hours are 8:30 am - 3:00 pm, Monday-Friday. The facility was toured inside and outside and the floor and yard plan submitted by the licensee were verified. The items which could pose a danger to children (such as detergents, cleaning compounds and medications) were observed to be inaccessible to children and locked in an inaccessible storage closet. Director stated there are no poisons in the facility, and none were observed during this inspection. The toys, floors, desks and other equipment and surfaces are clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors by use of water fountains in the classrooms and individual water bottles brought from home. The children's bathrooms is in safe and sanitary condition. Food prep areas are clean. Food is properly stored and refrigerated as needed. There was no contaminated food observed. Garbage cans containing solid waste have tight fitting lids. The LPA observed a working carbon monoxide detector in the facility. The playground was free of hazards. The playground equipment and surface areas were in safe condition. Continued on LIC 809-C
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2019
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,
, CA
FACILITY NAME: GAN ISRAEL PRESCHOOL
FACILITY NUMBER: 490102569
VISIT DATE: 04/03/2019
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Continued from LIC 809
There is playground graded recycled tire cushioning underneath climbing structures and/or play equipment to absorb falls. There were no bodies of water observed. Director stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met, and 26 children were being supervised by six staff. The facility was operating within the licensed capacity. At least one staff member present during the inspection possessed current CPR and First Aid certifications. The sign-in/sign-out procedure was reviewed and in compliance. Seven children’s records were reviewed at 10:30 am and contained signed admission agreements. Three staff records were reviewed at 10:50 am and contained documentation of education and training as required. This facility is not currently providing Incidental Medical Services (IMS). The Department’s IMS policy was discussed with the Director. 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: www.ada.gov/childqanda.htm. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were reviewed and discussed with the director. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Jennifer VelascoTELEPHONE: (707) 588-5044
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2019
LIC809 (FAS) - (06/04)
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