191202127-9-27-2022-12-CC-IORA-CJNSCQ-20220927134554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191202127
Report Date: 09/27/2022
Date Signed: 09/27/2022 01:46:04 PM

Document Has Been Signed on 09/27/2022 01:46 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
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

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: 25	DATE:	09/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Neli Plouzian		TIME COMPLETED:	01:55 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	On 09/27/2022 Licensing Program Analyst Isabel Ortega met with facility Director and conducted an Annual Random inspection. LPA toured and inspected the facility in accordance with the facility sketch. At time of entry LPA observed 25 children in care and 8 staff in the classrooms. There is a total of eight classrooms, according to facility currently only 5 classrooms are being utilized for care. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. LPA observed individual storage with children’s name labeled for children's belongings. Each classroom consists of filtered water containers with labelled water bottles for children. An isolation area was inspected, which takes place in the break room. Children are provided with a cot for nap time. Age appropriate sinks and toilets were inspected for availability and good repair. Toilets flush properly; toilet and sinks are reachable by the children. Each restroom has adequate toilet paper and paper towels available. Restrooms were found to be clean and sanitary. Facility operated Monday through Friday from 8:00 a.m. to 5:00 p.m.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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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Document Has Been Signed on 09/27/2022 01:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: TEMPLE AHAVAT SHALOM EARLY CHILDHOOD EDUCATION CT.	FACILITY NUMBER: 191202127
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation,interview and record review the facility did not comply with the section cited above in which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/07/2022
	Plan of Correction
1 2 3 4	Director will have staff take the mandated Reporter training by 10/5/22 on line and provide certificate of completion To the Palmdale RO by 10/07/22 by via-email.

Type B

Section Cited

CCR

101227(a)(16)

Food Service

(16) Pesticides and other similar toxic substances shall not be stored in food storerooms, kitchen areas, food-preparation areas, or areas where kitchen equipment or utensils are stored. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview the facility did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/03/2022
	Plan of Correction
1 2 3 4	Facility will relocation the chemicals and remove them from the food preparation area by 10/3/2022 and submit a picture to the Palmdale RO by 10/3/22

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: TEMPLE AHAVAT SHALOM EARLY CHILDHOOD EDUCATION CT.	FACILITY NUMBER: 191202127
	VISIT DATE: 09/27/2022

NARRATIVE

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First Aid supplies, smoke detectors, carbon monoxide and fire extinguishers were observed and in operable condition. Trash cans with tight lids were observed. The center provides food for the children enrolled. Food was inspected, and it was properly labeled, stored, and within expiration date. Refrigerator is clean and operating at the proper temperature. There is hot and cold running water in the kitchen/food preparation area. Food preparation area is adequately equipped, and clean. Cleaning supplies are out of reach of children. According to Title 22 food and chemicals may not be located in the same area where food is being prepared a B citation will be issued.

Emergency Drills are conducted monthly last drill was conducted on 8/27/2022 at 10:00 a.m. The fire extinguisher (2A10BC) is reading in green and meets the fire marshal codes and standards( last serviced 7/14/2022). The facility provides breakfast, morning snack, lunch, and afternoon meals. Food allergies are noted per classroom and are posted in the food preparation area. Menu is posted for parent review.

The two outdoor play areas were inspected and observed to be free of hazards, loose, or sharp objects. Equipment was inspected for safety, cushioning material, good repair and age appropriateness. Climbing structures other large play equipment were found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter. Children are provided with filtered individual water bottles. There is adequate shade area for rest. The playground is well fenced all around, and no bodies of water observed in the outdoor play area.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: TEMPLE AHAVAT SHALOM EARLY CHILDHOOD EDUCATION CT.	FACILITY NUMBER: 191202127
	VISIT DATE: 09/27/2022

NARRATIVE

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During the inspection LPA observed adequate teacher child ratio in each classroom. Care and supervision were evaluated and determine basic needs of children are appropriate and are being met. A review of the sign in/out sheet was conducted to verify the current census of children. The parent board was reviewed and has all the required forms posted accessible to parents.

Children's records were reviewed for completeness. Health History, Emergency contact and Medical Exams; Immunization Records are all in the children's file (blue cards will be requested by the department of Public Health and placed in child’s file). The facility roster was up to date and all staff have been fingerprinted and association to the designated license number. Director and teachers are currently certified in Pediatric CPR/First Aid which expires on 9/20/2023.

The following Incidental Medical Services (IMS) were discussed.
This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. 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

All staff are required to take 3-hour Mandatory Reporter training every 2 years, facility was not able to provide certificates for staff during inspection. www.mandatedreporterca.com. Therefore, a type B deficiency will be cited.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551

FACILITY NAME: TEMPLE AHAVAT SHALOM EARLY CHILDHOOD EDUCATION CT.	FACILITY NUMBER: 191202127
	VISIT DATE: 09/27/2022

NARRATIVE

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A copy of this report must be made available to the public for 3 years.

Beginning on January 1, 2018, Assembly Bill 1207 (2015) requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Applicants must meet requirements as a precondition to licensure. New employees shall have 90 days from date of employment to complete training as required. The training may be conducted at the following website www.mandatedreporterca.com. Director is aware self and all staff are mandated child abuse reporters and have the responsibility of reporting any suspected child abuse to the Child Abuse Hotline at (800) 540-4000.

For additional information and forms visit our website at: www.cdss.ca.gov

For updates on Community Care Licensing please visit the following website at: Childcareadvocatesprogram@dss.ca.gov
https://ccld.childcarevideos.org/

Per Title 22 facility was not in compliance and was cited two B deficiencies and technical advisories were provided. An exit Interview was conducted with Director, a copy of this Report and a Notice of Site Visit and appeal rights were issued on this day.

SUPERVISOR'S NAME: Carissa Bell	TELEPHONE: (661) 202-3359
LICENSING EVALUATOR NAME: Isabel Ortega	TELEPHONE: (661) 202-3786
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC809 (FAS) - (06/04)

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