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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417229
Report Date: 12/19/2019
Date Signed: 12/19/2019 02:40:38 PM

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:MOGEN DAVID SYNAGOGUE KEHILLAT,MOGENDAVID ECCFACILITY NUMBER:
197417229
ADMINISTRATOR:CECELIE WIZENFELDFACILITY TYPE:
850
ADDRESS:9717 W. PICO BLVD.TELEPHONE:
(310) 556-5609
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:55CENSUS: 41DATE:
12/19/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Cecelie WizenfeldTIME COMPLETED:
03:00 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
On 12/19/2019 at 2:00 PM Licensing Program Analyst (LPA) Angelica Ramirez conducted an unannounced case management inspection for the purpose of verifying if Individual 1 - Kelvin Trice is present at the facility based on a letter received from the Care Giver Background Check Bureau (CBCB) dated 09/20/19.

Upon arrival, LPA met with director Cecelie Wizenfeld who guided the LPA on a tour of the facility. LPA observed 18 children in care with three staff members present in the Pandas room (4-5 year olds), 12 children with 3 staff members in the Ducks classroom (3 year olds), and 11 napping children in the Cubs classroom (2 year olds) with two staff members . LPA informed Ms. Wizenfeld the reason for the inspection. See LIC812 for details regarding Individual 1.

The CBCB letter states that Individual #1 cannot work, be present or reside in the facility unless a criminal record exemption is granted. Upon arrival LPA did not observe Individual #1 present during today's inspection.

Ms. Wizenfeld advised Individual #1 is a former employee in the private elementary school which is located on the second floor of the same building where the preschool is located. LPA obtained a copy of the CBCB-2 Exemption Needed letter which was completed by Ms. Wizenfeld and sent to CBCB along with requested documentation in order to process the exemption.

No deficiencies were cited during today's inspection.
A copy of this report was provided to and discussed with director Ms. Wizenfeld. A notice of site visit was also provided and must be posted for 30 days.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Angelica RamirezTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2019
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 1