Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412177
Report Date: 09/28/2018
Date Signed 09/28/2018 05:46:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 121DATE:
09/28/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Cyrus Mallare TIME COMPLETED:
06:15 PM
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Licensing Program Analyst (LPA) Zaid Hakim conducted an Unannounced Required 3-Year Inspection at the facility today. Upon arrival, LPA observed one hundred and twenty one (121) school age children and at least twelve (12) staff engaging in daily activities and met with Mr. Cyrus Mallare, Director. The program operates on a campus with multiple licensee affiliated entities and is licensed to serve a maximum of 154 school age children ages Kindergarten through Twelve years old in classrooms D120, D123, Art Room, M121, M117, G100, and G103 only. Days and hours of operation are Monday through Friday 12:00pm to 6:00pm. LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Food Menus, and Activity Schedules. LPA observed during the inspection that all children were directly supervised by facility staff.

LPA reviewed a random sample of children's and staff files during today's inspection. Each child's file reviewed contained the following but limited to; The Emergency Identification Information (LIC 700) equivalent forms, Children's Personal Rights, and the Notification of Parent's Rights. All staff files reviewed contain the required transcripts, courses in the specified subject areas, and verification of experience. At least two staff on site at the time of the inspection maintain valid CPR/ First Aid certification with an expiration month of 06/2020. The Director stated that he understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips).

The Director stated that he understands the conditions, limitations, and capacity specifications of the facility License and the requirement that all children shall be visually supervised at all times. The Director is aware of the required sign in and sign out procedures for school age children who arrive at the facility on their own and those whom are transported by facility staff. The Director stated that all school age children are picked up by their respective parent(s)/guardian(s). The Director explained that facility staff communicate with school staff and parents regarding attendance and arrival to the program. LPA observed at the time of the inspection that an electronic sign in/ sign out system s used and is updated throughout the day, with each responsible party having a personalized security PIN. The Director stated that he understands that all children are required to be signed in and out and that staff must communicate with school representatives and parents regarding children who are transported.
REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #2 - REPORT DATED 09/28/2018):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2018
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: 09/28/2018
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CONTINUATION OF PREVIOUS PAGE (PAGE #1 - REPORT DATED 09/28/2018):

LPA observed that all activity areas are clean and safe for all children and staff. Drinking water is readily available for the children in the classroom and in the outdoor playground area via drinking fountains and cups and pitchers. LPA observed solid waste containers with tight-fitting lids in each room. Staff and children's bathrooms are clean, sanitary, and operable. The children in care use restrooms located throughout the campus which were observed to be clean and functioning. The Director stated that there are no weapons, firearms, and no bodies of water on the premises. There is a body of water located in the senior facility located on campus however staff and children do not have access. The food preparation and storage areas were observed to be clean and sanitary. All food and beverages that require refrigeration are stored in covered containers at 45 degrees F. or less. The facility has posted menus for snack foods served that are updated monthly. Cleaning supplies are inaccessible to the children and stored in locked cabinets. Any medications at the facility are securely stored, locked, and in an inaccessible location. Upon arrival to the program, children are observed by staff for illnesses. Emergency disaster drills are done as required, last of which done on 09/2018. The last Fire Inspection was conducted in 12/2017 in which fire and emergency systems were maintained. LPA observed that the facility is equipped with complete First Aid Kits, Fire Extinguishers, Smoke detectors, Carbon Monoxide detectors, and a central alarm system. The facility does provide transportation and the Director stated that staff are aware that children must not be left in vehicles unattended, seat belt and traffic laws must be obeyed at all times, and that maintenance logs are maintained.

LPA observed all furnishings and equipment to be age appropriate, in good condition, and in adequate supply for the licensed capacity. Children have cubbies designated for storage or personal items. The playground area used by the program are the play structures and a black top area. LPA and the Director discussed supervision requirements during outdoor play time. LPA observed that there is sufficient resilient materials in the outdoor playground area. LPA and the Director discussed AB 633, healthy beverages in child care, forms of discipline. The facility maintains an approved Incidental Medical Services (IMS) policy. Each classroom has a functioning telephone and staff communicate via walkie-talkies. LPA and the Director discussed emergency preparedness, lock-down procedures, and participation in campus wide emergency drills. The facility has been granted two department issued waivers for shared outdoor play areas and restrooms. LPA and the Director discussed waiver conditions and limitations.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

REPORT CONTINUED ON THE FOLLOWING PAGE (PAGE #3 - REPORT DATED 09/28/2018):
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2018
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: 09/28/2018
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CONTINUATION OF PREVIOUS PAGE (PAGE #2 - REPORT DATED 09/28/2018):

A review of staff records today indicate that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also discussed and reviewed immunization including Measles, Pertussis, and Influenza. LPA also reminded Licensee of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violation within a 12 month period.

LPA advised Facility Representatives of the new immunization requirement regarding Senate Bill 792 (pertussis, measles, and flu vaccines) for ALL STAFF THAT WORK DIRECTLY WITH CHILDREN and the required "Mandated Reporter" training that all staff will be required to complete starting January 1, 2018. LPA referred the Director to the Department website: www.ccld.ca.gov for additional information on the online training.

LPA advised the Director on the following items as a reminder:
- ALL STAFF who provide care and supervision to children in care are required to maintain immunizations on file per SB 792
- ALL STAFF who provide care and supervision to children in care are required to complete the required Mandated Reporter Training per AB 1207
- Room dividers in G100 and G103 should be secured per children's health and safety

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 Mr. Cyrus Mallare, Director.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Zaid HakimTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2018
LIC809 (FAS) - (06/04)
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