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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 414005013
Report Date: 08/05/2025
Date Signed: 08/05/2025 03:00:30 PM

Document Has Been Signed on 08/05/2025 03:00 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 CENTERFACILITY NUMBER:
414005013
ADMINISTRATOR/
DIRECTOR:		FRANCIS, NICOLEFACILITY TYPE:
830
ADDRESS:800 FOSTER CITY BLVD.TELEPHONE:
(650) 212-7522
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY: 41TOTAL ENROLLED CHILDREN: 41CENSUS: 0DATE:
08/05/2025
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Lauren Ngoi TIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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On 8/5/2025 at 8:35AM., Licensing Program Analyst (LPA) Luis Gomez met with Associate Director, Lauren Ngoi. This is an announced case management inspection- licensee initiated. Facility is requesting increase of capacity, 13 children (3 months to 24 months old), and room addition, Classroom #9, to existing infant program. This site is a combination center with a preschool and after-school program on site. Per associate director, several cribs have also recently been installed to classroom #10 and facility is requesting a measurement to ensure square footage requirements is met. Per Assistant Director, classroom #9, #10 will be used for younger infants, 0-12 months old. The facility will operate Monday - Friday; 8:00 AM to 5:30 PM. The facility was inspected today, indoor and outdoor, for health and safety hazards, and measured to calculate capacity.

At 8:50AM., LPA measured classroom #9 and classroom #10. Classroom #9 had a total useable indoor square footage of 545.6 sq ft. Total usable sq ft, divided by 35 equals to 15 children. LPA measured classroom #10. Classroom #10 had a total useable indoor square footage of 561.84. Total usable sq ft, divided by 35 equals to 16 children.

Classroom #9 are observed clean, neat, with age-appropriate plaything available. Floors and ground surfaces were clear of obstructions or hazardous items. Furniture and materials inspected was in good repair, free of sharp corners or splinters. Classroom has infant feeding chairs in facility.

Carpeting has been installed for added safety. LPA observed cabinets/ hooks available for infant’s personal belongings. Classroom #9 has sufficient storage for infant bedding and for other items (Diapers, Wipes, Ointments), which will be provided by their guardians.

For napping services, LPA observed several stackable cots, stored in classroom. Facility has designated the center of the room for the infant napping cribs. Per associate director, area will be maintained separate from the remaining activity space. Per associate director, sheets and blankets for older infants are to be provided by parents. Per associate director, the napping equipment and bedding will be laundered daily.

Per associate director, for food services, parents will provide bottles/nipples and any other food items for their child. The staff will ensure these items are sent home with the infants each day. LPA observed sink, with hot water, and a mini refrigerator. Facility was reminded, food items for each infant stored in the kitchen area or refrigerator and foods/ bottles, shall be properly labeled with the child's name and date. The food service area and diaper changing areas are located separately. LPA observed, classroom #9, has a diaper changing tables within arms reach of a sink. Changing table had a plastic, cleanable surface with raised sides. (REFER to 809C, FOR CONT.)

NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2025
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
FACILITY NUMBER: 414005013
VISIT DATE: 08/05/2025
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(Page 2)
Facility was reminded that cleaning products and other chemicals are not to be stored in the food area.
Per associate director, drinking water for the children will be provided by personal water bottles.

The medications for infants will be stored in the classroom.

Trash bins used for disposal of solid waste, was equipped with tight- fitted lid. The indoor space is equipped with a fire extinguisher, smoke/ carbon monoxide combination detectors (Built-In), first aid and emergency supplies.

There are three sinks in the infant classroom for children's usage. All sinks accessible to children deliver water no warmer than 120 degrees. Per director, potty chairs will be available if needed. There is a separate bathroom for staff at the facility. The isolation room for ill infant will be in the office.

The infant outdoor space had been previously measured, and had an allowable total capacity of 36 children. Facility was reminded to ensure all infants are provided with outdoor time each day. The outdoor area surface and equipment is observed to be clean, in good condition, and age appropriate. There are no climbing structures. The facility uses umbrellas to provide shade for the children. Drinking water will be made accessible to children by water bottles provided by the parents.

The following items were reviewed as part of today's visit: Record keeping for staff, children and facility records, maintaining and updating needs and service plans for infants, Care and Supervision of the Children, Child Discipline Procedures- talking and redirection will be used, Emergency Evacuation Procedures, Medication Policies, Isolation of Sick Children, Napping Requirements (Safe Sleep and SIDS discussed), Completion of Individual Infant Sleeping Plans and supervision of napping infants, Food Service for Infants, Transportation not provided, The Parents Rights, and Reporting Requirements. Associate director will ensure all require postings are displayed and visible to children’s authorized representatives at all times.


(REFER TO 809C, FOR CONT.)
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
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
FACILITY NUMBER: 414005013
VISIT DATE: 08/05/2025
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This facility will provide Incidental Medical Services – IMS. LPA reviewed storage area for medication and equipment/supplies, and reviewed forms that will be used. 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

During inspection, assistant director submitted the updated letter of intent, play yard schedule for rotational use, and parent handbook.



Prior to recommendation for increase of capacity/ room addition (classroom #9), facility will complete the following:
-Receive Fire Clearance approval (STD 850)
-Install cribs and separate napping area dividers in classroom #9
-Barricade the bathroom area (Toilets)
-Submit request to updated outdoor space waiver for rotational use of 36 children
-Submit updated LIC309, Administrative Organization
-Obtain infant feeding chair and tables for classroom #9

>No deficiencies were cited against the facility under CCR, Title 22, Div 12, Ch. 1.

This report must be available in the facility for public review. Notice of site visit was observed being posted. Associate director was advised any additional questions to call Office, M-F, 8:00am-5:00pm, 650-266-8800 or 1-844-538-8766. Website: www.cdss.ca.gov.
NAME OF LICENSING PROGRAM MANAGER: Marie Rodriguez
NAME OF LICENSING PROGRAM ANALYST: Luis Gomez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4