Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412177
Report Date: 06/01/2017
Date Signed 06/01/2017 10:44:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CLUB J AT THE OSHMAN FAMILY JCCFACILITY NUMBER:
434412177
ADMINISTRATOR:MALLARE, CYRUSFACILITY TYPE:
840
ADDRESS:3921 FABIAN WAYTELEPHONE:
(650) 223-8788
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY:154CENSUS: 0DATE:
06/01/2017
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Dave RosenfeldTIME COMPLETED:
11:00 AM
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
LPA Meela Aguas met with Licensee Representative, Dave Rosenfeld and Site Director, Cyrus Mallare for a case management inspection. The Licensee is replacing the current school age playground with the covered terrace. LPA toured the facility and measured the covered terrace. Measurements are as follows.

PRESCHOOL PLAYGROUND (near Art Room) Measurements taken 09/11/13 Report:
47 X 57.83 = 2718.01
23.474 X 62.581 = 1469.026
Total = 4,187.036

SCHOOL AGE PLAYGROUND (covered terrace):
93.333 x 34 = 3,173.322
TOTAL SCHOOL AGE OUTDOOR SPACE = 7,460.358 divided by 75 = 99 children

The center has a waiver for less outdoor space in relation to its indoor capacity.

New outdoor space will be used upon receipt of approved fire clearance


Notice of site visit was issued and must remain posted for 30 days..
SUPERVISOR'S NAME: Timetra FaulconTELEPHONE: (408) 324-2148
LICENSING EVALUATOR NAME: Milagros AguasTELEPHONE: (408) 334-8550
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2017
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 1