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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414000829
Report Date: 10/30/2025
Date Signed: 10/30/2025 04:08:50 PM

Document Has Been Signed on 10/30/2025 04:08 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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PENINSULA JEWISH COMMUNITY CENTER PRESCHOOLFACILITY NUMBER:
414000829
ADMINISTRATOR/
DIRECTOR:		LEVIN, STEPHANIEFACILITY TYPE:
850
ADDRESS:800 FOSTER CITY BLVD.TELEPHONE:
(650) 378-2670
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 231TOTAL ENROLLED CHILDREN: 231CENSUS: 84DATE:
10/30/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Nicole FrancisTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 10/30/2025 at 9:05AM., Licensing Program Analyst (LPA), Luis Gomez met with Director, Nicole Francis. The purpose of today's visit was explained and was for an unannounced,- annual random inspection. This facility is a combination center preschool with an infant and school-age program onsite. Present was the Director and 19 staff supervising 85 children. The days and hours of operation are Monday- Friday, 8:00-5:00PM. The staff present have criminal record clearances on file, and children have been signed-in by guardians. The preschool program utilizes 9 classroom: #4 (2 years old); #5 (3 year old); #7 (2 year old); #8 (2 years old); #11 (3 years old); #12 (4 years old); #13 (3 years old); #14 (3 years old); and #15 ( 4 year old); two shared, outside play areas (2’s yard and 3,4 ‘s yard); and the Multi-Purpose Room. LPA inspected facility, indoors and outdoors, for health and safety hazards.

At 9:40AM., LPA observed the following: Classrooms were clean and neat, with age-appropriate materials and playthings available for the children. The floor and surfaces were observed clean, and clear of obstructions or hazards.

The classrooms were equipped with several tables, chairs, and labeled cubbies for children’s belongings. All furniture inspected was scaled to the appropriate size. LPA advised facility to cover the exposed sharp cornered -furniture. The children’s bathrooms, located in each room, was observed clean with supplies for hand washing. The toilets and faucets inspected were in operating condition, and diaper changing tables were available as needed. The trash bins used for solid waste have been covered. LPA observed extra storage available in each classroom, with child safety locks installed.

For scheduled rest/ nap, LPA observed stackable plastic cots available in each classroom. Per director, blankets and napping supplies are washed weekly by families. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2025
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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PENINSULA JEWISH COMMUNITY CENTER PRESCHOOL
FACILITY NUMBER: 414000829
VISIT DATE: 10/30/2025
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(Page 2)
The classroom has adequate ventilation, lighting; and was a comfortable temperature for the children. Facility had a functioning telephone service and fire extinguishers (2A10BC) and carbon monoxide detector (Built into the building).

During inspection, LPA reviewed the facility kitchen. The kitchen was observed clean, and free of rubbish or vermin.

At 10:55AM., Based on observation, LPA confirmed expired foods (Yogurt) located in facility refrigerator. Per staff, items are going to be discarded today. Advisory Note: Technical Violation (LIC9102TV) was issued.

At 11:00AM, LPA reviewed the outside play areas (2’s yard and 3,4 yard) and multi-purpose room. LPA observed climbing structure was properly anchored, with absorbent material (wood chips) installed underneath. Both outside areas were enclosed with available shading and seated rest. LPA observed drinking water was available via refillable bottles, for children to drink as they wish.

At 11:30AM., LPA reviewed facility records including a sample of 5 children’s files and the personnel files. The personnel files reviewed contained Teacher's Proof of Qualifications; Notice of Employee Rights (LIC9052); Acknowledgement to Report Suspected Child Abuse (LIC9108); and Personnel Record.

At 12:45PM., Based on record review, LPA confirmed proof of updated mandated reporter training course (AB1207) missing from the facility files.

LPA reminded director to ensure the staff’s proof of immunization is stored in the facility records.

The children’s files were reviewed and contained the: Identification and Emergency Information; Notification of Parent’s Rights; Consent for Emergency Medical Treatment; Immunization Record; and Personal Rights (LIC613A). Facility is using customized set of forms/ information to for families to complete and sign acknowledgement.

Staff's Cardiopulmonary Resuscitation / Pediatric First Aid certification was current, expiring on: 8/2026.

The center is conducting emergency disaster drills (earthquake and fire) every 6 months, with last drills completed on: 5/14/2025, and 10/17/2025.

The required postings include the: Facility License; Notification of Parent’s Rights (PUB394); Personal Rights (LIC613A); The Passenger Safety Laws (PUB269); Outdoor Space Waiver; Menus (October, 2025); and Emergency Disaster Plan (LIC610).

LPA reminded director to update emergency disaster plan (LIC610) with currently employed staff. Advisory Note: Technical Violation (LIC9102TV) was issued. (REFER TO 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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 BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PENINSULA JEWISH COMMUNITY CENTER PRESCHOOL
FACILITY NUMBER: 414000829
VISIT DATE: 10/30/2025
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Assembly Bill (AB) 2370, chapter 676, statues 2018 requires all licensed child care centers (CCC’s) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and every five years after the date of the first test.

LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN21-21- CCP.

Director, Nicole Francis 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 Child Care Center. A civil penalty of $100.00 minimum/ day for maximum of 5 days or, if the penalty is repeat violation, for a maximum of 30 days per person will be assessment if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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/.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website athttps://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

Based on today's inspection, no deficiencies were cited in the areas evaluated according to the Title 22, Division 12, Chap. 1 Ca. Code of Regulations. An exit interview discussing facility evaluation report was conducted with Director, Nicole Francis. The director signature of this form acknowledges receipt of these documents.

This report must be made available in the facility for public review. Notice of site visit was provided and must remain posted for 30 days. Director was advised, any additional questions/ concerns to contact the San Bruno Regional Office, Mon-Fri, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.ccld.ca.gov

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC809 (FAS) - (06/04)
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