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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414002676
Report Date: 08/06/2024
Date Signed: 08/06/2024 05:44:04 PM

Document Has Been Signed on 08/06/2024 05:44 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 (SA)FACILITY NUMBER:
414002676
ADMINISTRATOR/
DIRECTOR:		LEVIN, STEPHANIEFACILITY TYPE:
840
ADDRESS:800 FOSTER CITY BLVDTELEPHONE:
(650) 378-2762
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 0DATE:
08/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Nicole FrancisTIME VISIT/
INSPECTION COMPLETED:
05:55 PM
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On August 6, 2024, at approximately 1:10 pm, Licensing Program Analyst (LPA) Maria Olguin-Leon, conducted an unannounced case management inspection at Peninsula Jewish Community Center After School Program. Facility submitted an application on May 9, 2024, for to add a new room to the Treehouse after school program. LPA met with Director, Nicole Francis, and explained the purpose of the inspection. Currently after school is on summer break and not in session.

Program is a licensed combination program for infants, preschool, and after school. The program is converting the youth office into Treehouse D classroom. Director was reminded that infants, preschool children and after school children cannot commingle with each other.

Treehouse D classroom, previous the youth office, was measured today to add to the Tree house after school program. Treehouse D classroom was measured for 863.8 sq ft. The total allowable capacity measured for Treehouse D classroom measures for 863.8 sq ft. equaling 24 children. Classrooms #13, #14 #15, Treehouse A, Treehouse B, Treehouse C will remain after school program classrooms. However, Classrooms #13 and #14 will only be used for preschool this upcoming school year 2024-2025.

Classroom is equipped with a centralized fire alarm system. Carbon monoxide and smoke alarm is built into the fire alarm system. LPA observed a fully charged fire extinguisher.

Room #15 bathroom is equipped with two toilet and a sink. Separate boy’s and girls’ restrooms are located on site, Bathrooms next to Treehouse A for boys includes one toilet, one urinal and two sinks, and girl’s bathroom includes three toilet, and two sinks. Second bathroom area (field bathroom) includes one toilet, one urinal, one sink for boys and four toilets, two sinks for girls. Bathrooms are used by school-age children to provide individual privacy.

Cont. page 2...
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE: DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2024
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
SAN BRUNO CC RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PENINSULA JEWISH COMMUNITY CENTER (SA)
FACILITY NUMBER: 414002676
VISIT DATE: 08/06/2024
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Director 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.

Fire inspection approval was received in Regional Office on June 19, 2024.

LPA will approve Treehouse D classroom for 24 children, upon removal of furniture and classroom set up. Director will submit photos to LPA once completed.

A copy of report, and the “Notice of Site Visit” were given to the director. A “Notice of Site Visit” must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



An exit interview was conducted, and the report was reviewed with the Director, Nicole Francis.
SUPERVISORS NAME: Marie Rodriguez
LICENSING EVALUATOR NAME: Maria Olguin-Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC809 (FAS) - (06/04)
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