191671596-3-16-2022-30-CC-LPHS-CCKVYV-20220316165145

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191671596
Report Date: 03/16/2022
Date Signed: 03/16/2022 04:51:54 PM

Document Has Been Signed on 03/16/2022 04:51 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	BETH SHOLOM TEMPLE NURSERY SCHOOL		FACILITY NUMBER:	191671596
ADMINISTRATOR:	RANDEE NORWOOD		FACILITY TYPE:	850
ADDRESS:	1827 CALIFORNIA AVENUE		TELEPHONE:	(310) 829-2517
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90403
CAPACITY:	60	CENSUS: 55	DATE:	03/16/2022
TYPE OF VISIT:	Case Management - COVID-19	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	ROBIN MASNICOFF		TIME COMPLETED:	12:00 PM

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On 3/16/2022, Licensing Program Analyst (LPA) Loyce Phillips, conducted a case management inspection to follow up on COVID-19 Positive Cases. LPA met with Director, Robin Masnicoff conducted a facility risk assessment, toured the facility and took a census. Upon arrival, there were 55 children and 11 staff present today at the facility. LPA toured 5 classrooms, children restrooms, kitchen and outdoor play area.

LPA observed the front entry displaying COVID-19 signs/posters and hand sanitizer. All the restrooms were functioning and fully stocked with soap, paper towels, gloves and disinfecting wipes. All the classrooms had hand sanitizer. The children are kept in the same cohorts throughout the day.

During the visit LPA and Director discussed the following:

Arrival Procedures - Visual checks are conducted daily on children and staff.

Face Mask - Mask are strongly recommended. Some children are still wearing face mask per the parents request.

Isolation area - The isolation area is located upstairs in the resource office. A designated staff will stay with the child until the parent arrives.

Cleaning and Disinfecting - The entire facility is fogged daily. The classrooms are disinfected daily. The children bathrooms are cleaned every hour. When choosing cleaning products, use products approved by Environmental Protection Agency list.

809 C

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: BETH SHOLOM TEMPLE NURSERY SCHOOL	FACILITY NUMBER: 191671596
	VISIT DATE: 03/16/2022

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PPE - The facility has sufficient amount of PPE supplies. The facility has KN95's mask, hand sanitizer, disinfected wipes, gloves, gowns and cleaning products.

Reporting Requirements – LPA explained and reminded Director to report all COVID-19 positives cases to Department of Public Health. When reporting Unusual Incidents, call CCLD within 24 hours and submit Unusual Incident Report within 7 days.

No deficiencies are being cited in accordance to Title22 of the California Code of Regulations and/or Health & Safety Codes.

An exit interview was conducted, a copy of this report and notice of site visit were provided to Robin Masnicoff.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce Phillips	TELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

LIC809 (FAS) - (06/04)

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