Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313616885
Report Date: 12/21/2015
Date Signed 12/21/2015 12:36:26 PM

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: 0DATE:
12/21/2015
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Malka KorikTIME COMPLETED:
12:45 PM
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Licensing Program Manager (LPM) Jennifer Brekke and Licensing Program Analysts (LPAs) Steven Lunn and Tanya Washington met with Licensee for the purpose of an Informal Meeting. LPM Brekke defined the difference between non-compliance and an informal meeting. LPM advised Ms. Korik that the purpose of today's meeting is to help provider gain compliance. Today’s Informal Meeting was to discuss the findings of the recent annual random visit dated 12/10/2015 and the facility compliance history. The following citations and regulations were discussed:
Criminal Record Clearance cited twice on 9/18/2013 and 12/04/2014; Limitations on Capacity and Ambulatory Status where a child enrolled in the toddler option was observed in the classroom with preschool children on 12/04/2014; Personnel Requirements for no staff member with CPR/First Aid certification; Personnel Records cited twice on 9/17/2013 and 11/06/2013; Care and Supervision where it was observed staff left the room to answer the front door, answer the phone in the office and go to the kitchen to get plates; Teacher - Child Ratio on 12/10/2015; Sign in and Sign out requirements where there was 10 children who were not signed in and/or listed on the sign in sheets; Buildings and Grounds for mice droppings in the water heater cabinet and Children’s records were all found incomplete on 12/10/2015.

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

DATE: 12/21/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2015
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
VISIT DATE: 12/21/2015
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Licensee stated that she understands that any employee working in the facility must have a criminal record clearance associated to the facility prior to working. Any volunteers working more than 16 hours per week also must have a criminal record clearance. Licensee brought in examples of staff and children's records and stated that she has hired a person to help her with the paperwork. Licensee also stated that the facility doors are locked and staff have remote clickers that would allow them to unlock the doors for parents without having to leave the classroom. Licensee stated that she has written a note to her parents reminding them to sign their child in and out daily. Licensee stated that she is also going to have an additional toilet installed in the next couple of weeks so she can apply for an increase in capacity. Licensee may expand the outdoor space as well. Licensee had a pest control company inspect the facility.

LPM Brekke informed Ms. Korik that continued deficiencies may result in further action, including a non-compliance meeting with the Regional Manager.

During the today's meeting LPM Brekke explained and provided Ms. Korik copies of the Self Evaluation Tool, Self Assessment Guide, Licensing Regulation Highlights, and also suggested to review the Departments web site www.ccld.ca.gov for updated regulations and important information regarding licensing. Director agreed to attend the Orientation on January 19, 2015 Record Keeping.
SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Steven LunnTELEPHONE: 916-216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2015
LIC809 (FAS) - (06/04)
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