Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412177
Report Date: 08/01/2018
Date Signed 08/01/2018 05:24:28 PM

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:
08/01/2018
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Dave Rosenfeld TIME COMPLETED:
06:00 PM
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Licensing Program Analyst (LPA) Zaid Hakim conducted an Announced Case Management - Licensee Initiated Inspection at the facility today. Upon arrival, LPA observed that the facility is currently not operating for the Summer months, resuming operation on 08/14/18, and met with Mr. Dave Rosenfeld, Director of Youth and Teen Programs and Mr. Cyrus Mallare, School Age Site Director. The OFJCC campus of the licensed facility is currently operating Summer Camp for school age children.

The purpose of the inspection was to observe a newly added building, with one classroom, an indoor patio area, and restrooms. During the inspection LPA also observed the newly added outdoor play area for school age children, which is an outdoor field equipped with a secure perimeter and fitness area. The facility is currently applying for an Increase of Capacity to serve a total of 174 children ages Kindergarten to Fifth Grade. The facility is also applying for a Waiver to allow the newly added outdoor play area to be used by members of the OFJCC community during days and hours of facility operation. LPA toured all areas noted above and obtained photos and detailed diagrams. LPA and facility representatives discussed secure perimeters of the outdoor play area, designated walkways for children, designated walkways for community members, and indoor and outdoor space requirements per the requested capacity.

LPA has informed facility representatives that indoor measurements for the capacity increase will be conducted upon Fire Clearance Approval from the local fire authority and that the Waiver for the shared outdoor play area is pending Community Care Licensing Management Approval.

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.
No Deficiencies were cited as a result of today's inspection.
Exit interview conducted with Mr. Dave Rosenfeld, Director of Youth and Teen Programs.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2018
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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