191202127-9-24-2019-12-CC-TLAN-BGBSX7-20190924141529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191202127
Report Date: 09/24/2019
Date Signed: 09/24/2019 02:15:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME:	TEMPLE AHAVAT SHALOM EARLY CHILDHOOD EDUCATION CT.		FACILITY NUMBER:	191202127
ADMINISTRATOR:	TESSA CRAMER		FACILITY TYPE:	850
ADDRESS:	18200 RINALDI PLACE		TELEPHONE:	(818) 360-5183
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91326
CAPACITY:	72	CENSUS:	DATE:	09/24/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:53 AM
MET WITH:	Tessa Cramer		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPAs) Lawson and Sims met with the facility Director, Tessa Cramer, for the purpose of conducting a Random Annual Inspection. A tour of the facility was conducted. Upon arrival LPAs observed five classrooms with a total of 33 pre-school children and 8 staff. The center operates from 7:30AM - 6:00PM Monday through Friday. Incidental Medical Services (IMS) policy was discussed. Furniture and equipment were inspected for age appropriateness and good repair. All rooms are clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. In each classroom there are cubbies for children's belongings. LPAs observed age appropriate toys and materials. Drinking water is available inside the classrooms in the form of water dispenser/ pitcher and personal water bottles. There is a fire extinguisher, smoke detector and a carbon monoxide detector on the premises. There is a First Aid Kit. LPA inspected and observed six bathrooms. Children mainly use the bathrooms located in the front of the school, one bathroom for girls (3 toilets and 2 sinks) and one for boys (2 toilets, 3 urinals and 3 sinks). Toilets and sinks are functioning properly and are age appropriate. LPAs observed soap, toilet paper and paper towels readily available. Additional sinks are located in each of the classrooms.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee Lawson	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: TEMPLE AHAVAT SHALOM EARLY CHILDHOOD EDUCATION CT.	FACILITY NUMBER: 191202127
	VISIT DATE: 09/24/2019

NARRATIVE

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Wellness Policy: Children are inspected for illnesses as they arrive. There is a separate area for isolation for ill children in the office area (there is a couch).

Outdoor play equipment was inspected for health, safety, cushioning material, good repair and age appropriateness. The play area has sand, grass and concrete. The area was observed to be free of debris. There is an area for shade and rest. Water pitcher and water bottles are brought outside during play. Play area was inspected and found to be free of hazards and inaccessibility to bodies of water. Climbing apparatus and large jungle gym are anchored.

There is a clean fully equipped kitchen (off limits) with refrigerator/freezer, stove, sink and microwave oven. The facility provides two snacks. Allergy lists are posted in the kitchen area and classrooms. LPAs observed an appropriate amount of snacks. The chemicals are kept separate from the food.

Sign in and out sheets were reviewed. The parent board was reviewed and has all of the required forms posted. Snack Menu is posted. Fire/earthquake drills current. Roster current.

Teacher child ratios were observed and staff name recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate.
Children's records and staff records were reviewed. Staff are certified in Pediatric CPR and First Aid expire 08/2020.

Unusual Incident reporting requirements were discussed, call within 24 hours and submit the form, LIC 624B, within 7 days.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee Lawson	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

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
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550

FACILITY NAME: TEMPLE AHAVAT SHALOM EARLY CHILDHOOD EDUCATION CT.	FACILITY NUMBER: 191202127
	VISIT DATE: 09/24/2019

NARRATIVE

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Additional forms and a copy of Title 22 Regulations may be obtained at the department's website www.ccld.ca.gov.
--Director was informed of responsibility to report suspected Child Abuse, 1-800-827-8724
--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov

Facility has one child with Incidental Medical needs. Medicine was stored properly. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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)/ (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

No deficiencies cited according to Title 22 Regulations. Consultation provided during the inspection.

Exit Interview conducted and a copy of report read and provided to Director, Tessa Cramer.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Tyicee Lawson	TELEPHONE: (661) 568-8103
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2019

LIC809 (FAS) - (06/04)

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