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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005166
Report Date: 07/22/2025
Date Signed: 07/22/2025 12:31:20 PM

Document Has Been Signed on 07/22/2025 12:31 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCHFACILITY NUMBER:
372005166
ADMINISTRATOR/
DIRECTOR:		FRAN FORMANFACILITY TYPE:
850
ADDRESS:4126 EXECUTIVE DRIVETELEPHONE:
(858) 362-1171
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 241TOTAL ENROLLED CHILDREN: 241CENSUS: 125DATE:
07/22/2025
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Fran FromanTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 7/22/25 at 8:30 am, Licensing Program Analyst, Annette Sutherland, visited the facility to conduct an annual inspection. LPA met with Director Fran Forman and proceeded to tour the facility. During today’s inspection, there were 125 children present with 31 Staff members in 13 class rooms. The facility is within ratio and capacity.

Appropriate care & visual supervision were also observed during the inspection while children were engaged in classroom.. The program operates Monday through Friday from 7:30 am. to 5:30 pm. with the preschool program officially operating from 9 am. to 3:30 pm. Furniture and age-appropriate equipment is in good condition. Rooms have adequate heating, lighting, and ventilation. No hazards were noted. Floors appear to be clean and safe. Drinking water is readily accessible. Bathrooms are maintained with operational toilets and faucets at an appropriate temperature. Paper towels and toilet paper are available. The food service area consists of a kitchen which is clean and free of hazards. Snack menu is posted. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 F or less. Children bring their own lunches from home Cleaning supplies are kept separate from food and are inaccessible to children. Storage containers for solid waste have tight-fitting covers and are kept in good repair.

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Annette Sutherland
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCH
FACILITY NUMBER: 372005166
VISIT DATE: 07/22/2025
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Facility has a security guards on property not in the licensed area. The facility appears to be free of insects and rodents. There is an operational carbon monoxide detector at the facility. Last emergency drill was conducted on 4/17/25 .

Outdoor play areas are fenced playgrounds (2) with sufficient material for cushioning. Climbing structures, swings and slides are securely fixed to the ground. The area has canopies used for shade. Equipment is age appropriate (ages 2-12 years – sticker on structure). There are no bodies of water in the licensed area, however the facility has swimming pools in the unlicensed areas for the community center used for the preschool children during the summer months. The swimming pools are on opposite side of the building away from the licensed areas. Preschool children are escorted by qualified teachers (teachers stay with the children during swimming time) and lifeguards are available in the pool. Facility only uses the pool during the summer months. Children go swimming 3 times a week.The pool for the younger children is fenced.

LPA reviewed, sign in/out sheets (electronic), a sample of personnel records for a health screening and on-the-job training. A sample of children's records for emergency information and a medical assessment. Children are evaluated upon entry and monitored throughout the day for signs of illness. The isolation are for ill children awaiting pick up is the front office.There are several staff present with current CPR and First Aid certification. SB 792 (staff immunizations)

Facility is reminded the Mandated Reporter Training is to be retaken every two years and can be accessed at the following website: www.mandatedreporterca.com.

LPA reviewed medication storage that is kept with facility nurse during summer months. There are currently no children in summer programs with IMS services. Personnel records contain health screening documentation and at least one staff member has current CPR and First Aid certifications. All staff have completed mandated reporter training and required immunizations. Each personnel record contains documentation of educational background and training. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions.

Toddler program is kept separate from preschool program at all times and has a separate toddler playground. Sleep logs for toddlers were reviewed.

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Annette Sutherland
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCH
FACILITY NUMBER: 372005166
VISIT DATE: 07/22/2025
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The facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. LPAs observed documentation from the facility that the water was tested for lead on 01/13/2023. LPAs discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleepas an additional resource. LPAs also informed facility representative 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. Facility representatives were informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of “medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. However, currently there are no children with IMS needs currently enrolled. For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

No Deficiencies were cited.

Exit interview conducted and report was reviewed with the facility Director Fran Forman. A notice of site visit was given and must remain posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Annette Sutherland
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4