Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313616885
Report Date: 11/21/2017
Date Signed 11/21/2017 01:26:41 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) 500-4522
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY:30CENSUS: 20DATE:
11/21/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Isroel KorikTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Keven Peters met with Isroel Korik for an annual/random inspection on the preschool age license. LPA toured the facility, including all activity/classroom areas, the isolation area, food service area, restrooms and outdoor play areas. LPA reviewed care and supervision of children, staffing ratios, health related services, including medications and first aid supplies, furniture, equipment, fire drills, drinking water and food service provisions. Today’s census was 16 preschool school age children with 3 staff, and 4 toddlers with 1 staff.

LPA observed all required forms to be posted. Some first aid materials were available. There are adequate toys and equipment available for preschool age children. The restrooms were observed to be in working order. The center provides snacks and menus were posted.

LPA reviewed the sign/in-sign/out sheet, children's and personnel records. All staff present had evidence of current criminal background clearances and associations. No staff today had current acceptable certificates of Pediatric CPR and First Aid.

LPA discussed recent changes in licensing requirements, including SB 277 and SB 792 pertaining to immunization requirements for children and staff. Review of staff files indicated that staff have not provided proof of immunization's.

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2017
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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: GAN YELADIM JEWISH PRESCHOOL
FACILITY NUMBER: 313616885
VISIT DATE: 11/21/2017
NARRATIVE
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LPA provided the Licensing Agency website (www.ccld.ca.gov), so the director and/or staff may obtain updated licensing information, regulations, and forms.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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

Title 22 deficiencies are cited on the subsequent pages of this report. Report was reviewed with Isroel Korik, exit interview conducted.

Notice of Site Visit was posted.

SUPERVISOR'S NAME: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2017
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: 11/21/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2017
Section Cited
HSC
1596.7995
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Employees or volunteers at day care center; immunization requirements; records; exemptions
(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza,
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Facility will provide LPA proof of staff immunization's by due date.
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pertussis, and measles. December 1 of each year. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
None of the staff has immunizations in their files that meets SB 792. This is a potential risk to children.
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Type B
12/20/2017
Section Cited
CCR
101216(f)
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Personnel Requirements. At least one person trained in CPR and Pediatric first aid shall be present when children are at the facility or offsite activities.
No staff present at the facility today had proof of current and acceptable CPR / First Aid certificates.
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Facility will provide current, acceptable Pediatric CPR/ First Aid certificates for at least 1 staff member present in the facility at all times.
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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: Jennifer BrekkeTELEPHONE: (916) 263-5717
LICENSING EVALUATOR NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2017
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2017
LIC809 (FAS) - (06/04)
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