013422036-4-26-2023-02-CC-ACUY-CR9QST-20230426122603

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013422036
Report Date: 04/26/2023
Date Signed: 04/26/2023 12:26:15 PM

Document Has Been Signed on 04/26/2023 12:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	GAN MAH TOV PRESCHOOL		FACILITY NUMBER:	013422036
ADMINISTRATOR:	BENCUYA, ANNA		FACILITY TYPE:	830
ADDRESS:	3778 PARK BLVD		TELEPHONE:	(949) 378-7167
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94610
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 9	CENSUS: 10	DATE:	04/26/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Anna Bencuya		TIME COMPLETED:	03:00 PM

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	On 04/26/2023 at 12:00PM Licensing Program Analyst (LPA) A. Curry conducted an unannounced required inspection LPA met with director, Anna Bencuya, who guided LPA on a tour of the facility. This is an infant program licensed for 14 children. This facility operates Monday – Friday from 8:30 AM – 5:00 PM. Per the director there are 9 children enrolled. This is a combination center with preschool license on site, License # 010210219. LPA A. Curry began facility tour and all areas identified on the facility sketch were inspected. Upon arrival, LPA observed 10 infants with 3 Staff and 1 student volunteer. Teacher-infant ratios were observed to be in accordance with Title 22 regulations. The Licensee is within the conditions, limitations, and capacity specified on the license. Staff names were recorded. All children were observed to be under visual supervision of a teacher at all times. Classrooms were observed to ensure that infants are never left unattended and under the direct visual supervision of a staff person at all times. The facility was inspected to ensure that it is clean, safe, sanitary, and in good repair to ensure the safety and well being of children, employees and staff. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. The facility has age appropriate furniture and equipment including but not limited to cribs, cots/mats and changing tables. LPA observed that infant changing tables are within an arm’s reach of a sink. LPA observed sufficient infant napping equipment that meets the requirements of Title 22 regulations. LPA did not observe any baby walkers or any items that fall into that category present in the facility. At this time, the office is used as an isolation area. Parents are contacted immediately when children are determined to be ill.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GAN MAH TOV PRESCHOOL	FACILITY NUMBER: 013422036
	VISIT DATE: 04/26/2023

NARRATIVE

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The facility does not provide any meals for infants all food is provided by parents. LPA observed that bottles, dishes, and containers of food brought by the infant’s authorized representatives are labeled with the infant’s name. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to infants. LPA A. Curry advised director that storage areas for poisons need to be kept locked. The director indicated the facility has a centralized carbon monoxide detector, which was last tested a couple weeks ago. The facility takes measures to keep the facility free of flies, other insects, and rodents.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. LPA did not observe any bodies of water during this visit.

Sign in and out sheets were reviewed to ensure that children present are signed in. Staff Records were reviewed to ensure that personnel records are maintained on all staff. Children’s Records were reviewed to ensure that each child has a complete file. LPA’s observed the LIC 9227 Individual Infant Sleeping Plan in files. Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GAN MAH TOV PRESCHOOL	FACILITY NUMBER: 013422036
	VISIT DATE: 04/26/2023

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Licensee was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with director Anna Bencuya.

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC809 (FAS) - (06/04)

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