191202127-1-22-2020-12-CC-MRAN-BLL2UY-20200207164306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191202127
Report Date: 01/22/2020
Date Signed: 01/22/2020 02:11:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2019 and conducted by Evaluator Lady King

COMPLAINT CONTROL NUMBER: 12-CC-20191120161446

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: 37	DATE:	01/22/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tessa Cramer		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Personal Rights: Staff failed to meet child's diapering needs.
Personal Rights: Child has an unexplained bruise
Lack of supervision resulting in child being injured while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On January 22, 2019 Licensing Program Analyst (LPA) LPA King conducted a subsequent complaint investigation for the purpose of concluding the investigation regarding the above allegations. Upon arrival, LPA met with Director, Tessa Cramer

During the course of the complaint investigation, LPA conducted file review, interviews with staff, and other relevant parties related to the allegations. The investigation shows there were enoungh staff to meet the department regulations.
Based on the statements and interviews obtained during investigation. There were inconsistent statements concerning the above allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged allegations did or did not occur, therefore the above allegation is unsubstantiated.

Exit interview was conducted, appeal rights and a copy of this report was read and given to Director.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Mariela Ramon	TELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Lady King	TELEPHONE: (661) 568-8933
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2