Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313616885
Report Date: 12/10/2015
Date Signed 12/16/2015 09:15:00 AM

COMPREHENSIVE INSPECTION
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) 677-9960
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:15CENSUS: 21DATE:
12/10/2015
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Malka KorikTIME COMPLETED:
04:00 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
(1) Licensing Program Analysts (LPAs) Steven Lunn and Tanya Washington met with director for a random/annual visit. LPA toured the building including the activity/classroom areas, food service area, restroom and outdoor play area. Facility hours are 9:00am-1:30pm. LPAs observed the care and supervision of children, staffing ratios, health related services, including medications, furniture, equipment, drinking water and food service provisions. There were two teachers and two parent volunteers in the facility. Director stated that the children bring their lunches, and only snacks are served to the children. LPAs reviewed the sign/in-sign/out sheet and observed that some signatures were missing, LPAs were able to verify that at least one staff member present today had current Pediatric CPR and First Aid certification. All staff currently employed with the facility have criminal record clearances, and there are no firearms or bodies of water on the property. LPAs reviewed children's and staff files. LPAs discussed with designee any changes that may occur regarding the director or an employee acting in director's absence must be reported to department within 10 working days.

Deficiencies were observed at the time of the visit.

Continue on LIC809C

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Steven LunnTELEPHONE: 916-216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2015
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 5


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: 12/10/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/10/2015
Section Cited
101216.3(a)
1
2
3
4
5
6
7
Teacher – Child Ratio. There shall be a ratio of one teacher supervising no more than 12 children in attendance except as specified in (b) and (c). LPAs observed 14 preschool age children and one teacher in the front part of the room, and 7 children and 1 teacher in the separated area of the room. There were also 1 parent volunteer in both areas.
1
2
3
4
5
6
7
Director stated that more staff will be hired, she will also fill in when needed. The director stated she will contact some families and work out a schedule that will not put the facility overcapacity.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Steven LunnTELEPHONE: 916-216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2015
LIC809 (FAS) - (06/04)
Page: 2 of 5


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
VISIT DATE: 12/10/2015
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
26
27
28
29
30
31
32
Director was informed of a required informal meeting that will be held at the Regional Child Care Office. Appeal Rights explained. All appeals must be in writing and received by the licensing office within 10 days. Regulations can be obtained through CCLD website: www.ccld.ca.gov. This report is to be on file and accessible for public review at the facility for at least 3 years. Notice of site visit posted. LPAs conducted exit interview.

Licensee acknowledges, that, FOR TYPE A DEFICIENCIES ONLY, upon receipt, licensee shall post LIC809D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. The LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee (LIC 9224 was provided) (LIC311A was provided during the visit)

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Steven LunnTELEPHONE: 916-216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2015
LIC809 (FAS) - (06/04)
Page: 3 of 5


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: 12/10/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2015
Section Cited
101238(a)(1)
1
2
3
4
5
6
7
Buildings and Grounds. The licensee shall take measures to keep the center free of flies, other insects and rodents. LPAs observed mice droppings in the water heater cabinet. Director stated they have a pest control company that sprays once a month.
1
2
3
4
5
6
7
Director to submit written plan of correction to licensing by 12/11/2015.
Type B
12/11/2015
Section Cited
101238.2(d)
1
2
3
4
5
6
7
The surface of outdoor activity space shall be maintained in safe condition.
LPA's observed wripped tarp in the playground. The tarp is a tripping hazard to children.
1
2
3
4
5
6
7
Director stated that the tarp pieces that are sticking from the ground will be cut off, the area will be resurfaced and refilled with more bark.
Type B
12/11/2015
Section Cited
101217(a)
1
2
3
4
5
6
7
Personnel Records. Personnel records shall be maintained on the licensee, administrator, and each employee, and shall contain specified information. LPA reviewed personnel files which were all incomplete.
1
2
3
4
5
6
7
Director to submit written plan to bring personnel files up to date by 12/11/2015.
Type B
12/11/2015
Section Cited
101221(a)
1
2
3
4
5
6
7
Child’s Records. The licensee shall ensure that there are separate, complete and current records kept for each child attending the child care center. LPA reviewed children's records and files were found incomplete for all files.
1
2
3
4
5
6
7
Director stated her husband completes the children's files and will have him update the files within a week. Director to submit in writing when files for children will be complete to licensing by 12/11/2015.
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: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Steven LunnTELEPHONE: 916-216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2015
LIC809 (FAS) - (06/04)
Page: 4 of 5


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: 12/10/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2015
Section Cited
101229.1(b)
1
2
3
4
5
6
7
Sign In and Sign Out
The person who brings the child to, and removes the child from, the center shall sign the child in/out. LPAs observed sign in sign out sheets were not signed by 10 parents.
1
2
3
4
5
6
7
Director stated she will notify parents through email regarding signing their child in/out daily by 12/11/2015. Director to include LPA on email.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Steven LunnTELEPHONE: 916-216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2015
LIC809 (FAS) - (06/04)
Page: 5 of 5