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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434412177
Report Date: 04/11/2025
Date Signed: 04/11/2025 02:08:39 PM

Document Has Been Signed on 04/11/2025 02:08 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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:CLUB J AT THE OSHMAN FAMILY JCCFACILITY NUMBER:
434412177
ADMINISTRATOR/
DIRECTOR:		NIVERA, BRAYLENFACILITY TYPE:
840
ADDRESS:3921 FABIAN WAYTELEPHONE:
(650) 776-1348
CITY:PALO ALTOSTATE: CAZIP CODE:
94303
CAPACITY: 192TOTAL ENROLLED CHILDREN: 192CENSUS: 0DATE:
04/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Dave RosenfeldTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 04/11/2025 at 9:00am, Licensing Program Analyst (LPA) Jialing “Julianne” Zhu and Licensing Program Manager (LPM) Chandra Charles met with Director Braylen Nivera and Senior Director of Youth and Teens Program Dave Rosenfeld for an announced case management inspection. The purpose of the inspection was to REMOVE 3 rooms (E104, G100, and G103) from licensed space and ADD 4 rooms (Room A, Room B, Room C, and D129). The facility is not requesting a change in its capacity. Fire clearances for Rooms A, B, C, and D129 was granted by the Palo Alto Fire Department on 03/25/2025.

There were no additional staff or children present at the facility during today’s inspection as the facility was closed for break. The facility was toured to conduct a Health and Safety Inspection. The facility is located on the premises of the Oshman Family Jewish Community Center (OFJCC). A licensed preschool with a toddler component (facility #: 434410805) is also on premises.

Classrooms: This facility will have nine (9) classrooms (D120, D123, D129, M117, M121, Room A, Room B, Room C, 2nd Floor Pavilion) for school-age children. The school age rooms are equipped with varied age-appropriate materials and equipment. LPA conducted measurements of newly added rooms during today’s inspection.

Measurements for new indoor spaces (Room A, Room B, Room C, and D129):


Room A: 997.36 + 14 minus 29.14 (encumbered space) = 982.23 sq ft
Room B: 368.07 minus 49.56 (encumbered space) = 318.51 sq ft
Room C: 1070.05 + 14 minus 32.84 (encumbered space) = 1051.21 sq ft
D129: 590.34 minus 24.75 (encumbered space) = 565.59 sq ft
Previously measured indoor spaces (D120, D123, M117, M121, and 2nd Floor Pavilion): 3861.671 sq ft
Previously measured outdoor spaces (Field Area, 2nd Flr Pavilion Patio, Shared Play Space): 15990.43 sq ft
Page 1 of 3. See LIC 809C.
NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Jialing Zhu
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CLUB J AT THE OSHMAN FAMILY JCC
FACILITY NUMBER: 434412177
VISIT DATE: 04/11/2025
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Total Measurements & Capacity:

Indoors: 6705.53 sq ft divided by 35 (sq footage per child) = 192 children

Outdoors: 15990.43 sq ft divided by 75 (sq footage per child) = 213 children

Outdoor Play Area: This facility will have three (3) outdoor play areas (Outdoor Field Area with Gaga Pit, 2nd Floor Pavilion Patio, and Preschool Play Yard) available for children. A waiver granted by Licensing permits the shared usage of the preschool play yard between Club J and T’enna Preschool with conditions. There are two (2) pools on the premises of OFJCC; neither are licensed by CCLD. Both pools are indoor pools with their own secured entrance, which requires a keycard to open the doors. Per director, some children do enroll in swimming classes in the Aquatics Center. Parents sign a Club J Agreements form that has a clause on Club J Walk Permission. This permission gives consent to teachers to sign children out of Club J and take them to a non-Club J program located at the OFJCC. The Aquatics Center is one of the non-Club J programs included in the permission.

Bathrooms: A waiver granted by Licensing permits school-age children attending Club J to have access to the first-floor pavilion restrooms with conditions. The facility will need to request a waiver for usage of second-floor pavilion restrooms. LPA observed there are 17 toilets, 7 urinals and 18 sinks available for children use. Toilets used by school-age children provides individual privacy. Staff have separate designated bathrooms on premises. Director's office and bathroom nearest Director's office will serve as isolation areas for ill children.

Record Keeping and Reporting Requirements: Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Mandated Reporter Training ("Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting https://mandatedreporterca.com/. Facility roster and personnel report must be properly maintained, and fire/disaster drills must be conducted at least every six (6) months and documented. Effective August 1, 2003 California Law requires Child Care Licensees to report unusual incidents or injuries to children in care to child’s parents and to the Department of Social Services using the Unusual Incident/Injury Form (LIC 624). Incidents must be reported within 24 hours to the regional office by phone and the written report, LIC 624, within seven (7) business days. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov.

Page 2 of 3. See LIC 809C.

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Jialing Zhu
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
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
OAKLAND SOUTH CC RO, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME: CLUB J AT THE OSHMAN FAMILY JCC
FACILITY NUMBER: 434412177
VISIT DATE: 04/11/2025
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Criminal Record Clearance: 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.

Lead Testing: Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. LPA referred director to the Department website for lead: Lead Toxicity Prevention and Water Testing Information. LPA reminded director taps used for drinking and/or food prep in new rooms added to the license are required to be tested prior to usage.

Director was also reminded smoke and carbon monoxide detectors are to be present in the rooms added during today’s inspection.

Room changes and room addition requested by director has been approved as of today, 04/11/2025. The current nine (9) rooms licensed for this school-age facility are as follows: D120, D123, D129, M117, M121, Room A, Room B, Room C, 2nd Floor Pavilion. The capacity remains at 192 children. The Yad B Yad classroom between the 2nd Floor Pavilion and Rooms A, B, and C is not licensed by CCLD. However, the Yad B Yad classroom will be used strictly as a walkthrough for children to access Rooms A, B, C.

No deficiencies were cited during today's inspection. A Notice of Site Visit was given and must remain posted for 30 days. Exit interview was conducted and report was reviewed with Director Braylen Nivera.

Page 3 of 3. End of Report.

NAME OF LICENSING PROGRAM MANAGER: Chandra Charles
NAME OF LICENSING PROGRAM ANALYST: Jialing Zhu
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4