<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202136
Report Date: 08/11/2022
Date Signed: 08/11/2022 03:30:44 PM


Document Has Been Signed on 08/11/2022 03:30 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:TEMPLE RAMAT ZION NURSERY SCHOOLFACILITY NUMBER:
191202136
ADMINISTRATOR:PASTERNAK, ADRIANNEFACILITY TYPE:
850
ADDRESS:17655 DEVONSHIRE STTELEPHONE:
(818) 360-1881
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:60CENSUS: 22DATE:
08/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Hayley Wood - DirectorTIME COMPLETED:
03:45 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 08/11/2022 Licensing Program Analyst (LPA), Suzette Ornelas conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director, Hayley Wood, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday 8a-5p.

LPA observed all required postings in a prominent area. A review of the sign in/out sheet was conducted to verify the current census of children. LPA observed 22 children and 5 adults. A walk through of the classroom areas was conducted. LPA observed 5 classrooms utilized for care. Room 2 and 4; are not currently being used during the summer. Room 5, 6 and 8/9 are currently being used for providing care. LPA observed all children are under supervision, including visual supervision, of a teacher at all times. Capacity and limitations as specified on the license are being maintained. LPA observed the main child restroom located next to Room 6 which consists of 5 toilets, 4 sinks and a changing table area. Floors in the facility are clean and safe. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition and free of hazards. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. All food preparation and storage areas are clean and safe. Per director, parents provide daily meals; however, school offers snacks as needed. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. The facility is free of flies, insects and rodents. The facility is equipped with working dual carbon monoxide detector and smoke detector as well as fire extinguishers (2A 10BC) located in all classrooms. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. No poisons were observed during the inspection.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TEMPLE RAMAT ZION NURSERY SCHOOL
FACILITY NUMBER: 191202136
VISIT DATE: 08/11/2022
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
26
27
28
29
30
31
32
 Although there is a toddler option on the premises, there are currently no toddlers enrolled. LPA provided director with infant safe sleep regulation information for all children 0-2 years old. The facility has sufficient cots or mats for napping. Each mat or cot is occupied by only one child at time. LPA reviewed a sample of children’s files and observed files were complete. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. LPA reviewed a sample of staff files and observed files were complete. LPA reminded director to ensure Mandater Reporter training is complete by all employees every 2 years and readily available for the department to review. LPA provided director with a copy of the Disaster and Mass Casualty Plan regulation and information on ensuring the plan follows regulating requirements, to be maintained at the facility moving forward.

Incidental Medical Services (IMS) are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3