Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412177
Report Date: 09/18/2018
Date Signed 09/18/2018 01:37:16 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:
09/18/2018
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dave Rosenfeld TIME COMPLETED:
01:45 PM
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Licensing Program Manager (LPM) Tony Studebaker and Licensing Program Analyst (LPA) Zaid Hakim conducted an Announced Case Management - Other Inspection at the facility today. Upon arrival, LPA observed that there were currently no school-age children on site and met with Mr. Dave Rosenfeld, Director of Schoolage Programs. The facility is currently applying for an increase of capacity from 154 to 174. 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. LPM and LPA also conducted measurements of all indoor and activity areas. Measurements are as follows:

-Second Floor Pavilion (Newly Constructed Building)
46 x 15 = 690 SQ+ 46.250 x 15.583 = 720.713 SQ minus encumbered space - 24.216
1410.713 - 24.216 = 1,386.497 SQ

-Classroom G103
38.083 x 25.833 = 983.798 SQ minus encumbered space - 25.583
983.798 - 25.583 = 958.215 SQ

-Classroom D117
36 + 42.333 x 23.167 + 4 x 4.333
1061.317 SQ minus encumbered space - 15.075
1061.317 - 15.075 = 1046.242 SQ
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 09/18/2018):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2018
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 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CLUB J AT THE OSHMAN FAMILY JCC
FACILITY NUMBER: 434412177
VISIT DATE: 09/18/2018
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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 09/18/2018):

Indoor Square Footage Totals:
1,386.497 SQ + 958.215 SQ + 1046.242 SQ + 473.718 SQ + 344.426 SQ + 1214.427 SQ+ 368.942 SQ + 936.895 SQ = 6729.362 SQ divided by 35 = 192.267

Outdoor Square Footage Totals:
10,547.219 SQ + 970.005 SQ + 4397.166 SQ + 83 SQ = 15,997.39 SQ divided by 75 = 213.298

In total the children have access to the following: 7 urinals, 15 sinks, 15 toilets

LPM, LPA, and the Director discussed the use of the newly constructed field as an outdoor play area. The outdoor play area will also be open to members of the OFJCC community during days and hours of operation. The facility will apply for a waiver outlining the following:
- Schedule of outdoor play times
- Perimeter fencing in the areas designated for children in care
- How the perimeter fencing will be installed each day prior to children using the outdoor play area
- Requesting approval for shared outdoor play space with the members of the OFJCC community.
- Requesting approval for shared use of the first floor pavilion bathrooms

Based on the square footage measurements taken both indoor and outdoor during today's inspection:
The facility request to increase capacity from 154 to 174 will be APPROVED pending approval above the Waivers noted above.

A Notice of Site Visit has been issued and must remain posted for 30 consecutive days.

No Deficiencies have been cited as a result of today's inspection.
Exit interview conducted with Dave Rosenfeld, Director of Youth Programs.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2018
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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: CLUB J AT THE OSHMAN FAMILY JCC
FACILITY NUMBER: 434412177
VISIT DATE: 09/18/2018
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 09/18/2018):

Classroom D120
22 x 19.667 = 432.674 + 11 x 4.750 = 484.924 minus encumbered space - 11.206
484.924 - 11.206 = 473.718 SQ

Classroom D123
17.667 x 21 = 371.007 minus encumbered space - 26.581
371.007 - 26.581 = 344.426 SQ

Classroom M121
47.167 x 26.083 minus encumbered space - 15.829
1230.256 - 15.829 = 1214.427 SQ

Classroom M117
17.167 x 22 minus encumbered space - 8.732
377.674 - 8.732 = 368.942 SQ

Classroom G106
37.667 x 25.917 + 1.333 x 6.583 minus encumbered space - 39.32
976.245 - 39.32 = 936.895 SQ

Outdoor Measurements are as follows:
Outdoor Field Area (Newly Constructed)
114.333 x 92.250 = 10,547.219 SQ
-Second Floor Pavilion Patio
39.667 x 15 + 15 x 25 = 970.005 SQ
-Shared Outdoor Play Space
37.333 x 44.417 + 62.500 x 27.667 + 27.667 x 37.333 minus the encumbered space - 23.127
4420.293 - 23.127 = 4397.166 SQ

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 09/18/2018):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2018
LIC809 (FAS) - (06/04)
Page: 3 of 3