197418383-11-4-2024-58-CC-SGAN-DAPRDG-20241104115554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418383
Report Date: 11/04/2024
Date Signed: 11/04/2024 11:56:05 AM

Document Has Been Signed on 11/04/2024 11:56 AM - 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:	YESHIVA KETANA OF LOS ANGELES PRESCHOOL		FACILITY NUMBER:	197418383
ADMINISTRATOR/ DIRECTOR:	FORMAN, ELLEN		FACILITY TYPE:	850
ADDRESS:	12131 BURBANK BLVD.		TELEPHONE:	(818) 766-7610
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY: 60	TOTAL ENROLLED CHILDREN: 54	CENSUS: 49	DATE:	11/04/2024
TYPE OF VISIT:	Required - 3 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	07:15 AM
MET WITH:	Ellen Forman, Director		TIME VISIT/ INSPECTION COMPLETED:	11:40 AM

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	Licensing Program Analyst (LPA) Silva Garibyan conducted an unannounced Required - 3 year inspection. LPA met with Ellen Forman, Director, who guided analyst on a tour of the facility. This is a preschool program serving up to 60 children. The facility's hours of operation are from 8:00 AM to 4:00 PM M-Th and from 8:00 AM to 1:45 PM Fridays. There were 4 teachers and 4 aides on the premises along with the director ( one teacher and one aide in each classroom). Facility is operating within capacity limitations. The facility consists of 2 buildings with a total of 6 classrooms. The front building has 4 classrooms that care for younger preschool children; ages 3-4 years. The back building consists of 2 classrooms for older preschoolers, ages 4-5 years. LPA observed 13 children in Nursery (1) room supervised by one Teacher and one Aide, 14 children in Nursery (2) classroom supervised by one Teacher and one Aide, 12 children in Kindergarten (1) supervised by one Teacher and one Aide, and 10 children in Kindergarten (2) supervised by one Teacher and one Aide. LPA verified that all adults present in the facility have obtained criminal record clearances and are associated to the facility. LPA reviewed the sign in and sign out sheet to verify the census. There are no bodies of water on the premises during the visit. LPA observed the following postings in each classroom and by Director's office: License, LIC 613A, the PUB 393, Child Care Center Notification of Parents' Rights Poster, LIC 610 Emergency Disaster Plan with the telephone number of the local health department, information on child passenger restraint systems (PUB269). Furniture and equipment were inspected for age appropriateness and good repair. The classrooms were inspected to ensure that the floors have a surface that is safe and clean. A walk through of the classrooms was conducted, classrooms were found to be clean and free from any potential hazards. Furniture was found to be in good repair and age appropriate. Page 1

Betty Bell	TELEPHONE: (424) -301-3063
Silva Garibyan	TELEPHONE: (424) 301-3062
	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YESHIVA KETANA OF LOS ANGELES PRESCHOOL	FACILITY NUMBER: 197418383
	VISIT DATE: 11/04/2024

NARRATIVE

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There is adequate heating, lighting and ventilation. Drinking water is readily available in each classroom. LPA observed water dispensers in every classroom. Drinking water is available inside the classrooms in the form of a water dispenser, pitchers and disposable cups. The pitchers and cups are taken outside when children go out to play. There are first aid supplies in each classroom and school Principle's office.

Children have adequate cubby storage for their belongings in each classroom. The center provides sheets and blankets and laundered weekly or more often if needed. Age appropriate restroom, sinks(7) and toilets(5) were inspected for good repair, water temperature, toilet paper, safety and sanitation. All available toilets and sinks are in operable condition. Bathrooms were found to be clean. There is adequate lighting/ventilation in the bathrooms.

Children are inspected for illnesses as they arrive. A review of medication policy indicated that Medication is administered by the director, who documents the date, time and dosage onto a log. Medications are stored securely and inaccessible to children. There is a separate area for isolation and care of ill children in Director's office. There is a mat available for each ill child. An isolated toilet and sink are available for ill children (Staff Bathroom).

Lunches are not prepared by the school, parents provide the lunches and snacks. Cleaning supplies are out reach of children and is stored separately and away from food. There is adequate food for snacks. Refrigerator is clean and operating at the proper temperatures. Solid waste storage containers have tight-fitting covers and are in good repair.

Outdoor play equipment and toys were observed to be in good condition. Shade is available on the yards. Fencing around the perimeter of the play area is at least 4 feet high.

The facility is equipped with a working smoke detectors and Carbon Monoxide detector. LPA observed fire extinguishers (2A 40BC) in all classrooms with service date of 11/16/2023. First Aid Kit was observed to be complete. Fire Drill log was observed to be complete and current.
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SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: YESHIVA KETANA OF LOS ANGELES PRESCHOOL	FACILITY NUMBER: 197418383
	VISIT DATE: 11/04/2024

NARRATIVE

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The facility has sufficient mats for napping. LPA reviewed a sample of children’s files and observed files were complete. LPA reviewed a sample of staff files. CPR, Pediatric First Aid (Director completed on 08/28/24) and Mandated Reporter Training (Director Completed on 01/23/2023) were observed to be current. Health-Screening reports and Immunization records are missing in staff files. The name of the child care center director or fully qualified teacher designated to act in the director’s absence has been reported to the Department.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Director was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

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SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YESHIVA KETANA OF LOS ANGELES PRESCHOOL	FACILITY NUMBER: 197418383
	VISIT DATE: 11/04/2024

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for
drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.
For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP).
LPA verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Ellen Forman.

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SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) -301-3063
LICENSING EVALUATOR NAME: Silva Garibyan	TELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 11/04/2024 11:56 AM - 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: YESHIVA KETANA OF LOS ANGELES PRESCHOOL	FACILITY NUMBER: 197418383
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, staff did not have their immunization records in the file during the inspection, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/11/2024
	Plan of Correction
1 2 3 4	Director will have staff obtain their immunization records and notify LPA when completed by November 11, 2024

Section Cited

Personnel Requirements

(2) Each person specified in (g) above shall have a health-screening report signed by the person performing the screening. This report shall indicate the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above. Staff did not have Health-screening reports on files,which poses/posed a potential health, safety or personal rights risk to persons in care
	POC Due Date: 11/11/2024
	Plan of Correction
1 2 3 4	Director will obtain records by POC due date of 11/11/2024

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

Betty Bell	TELEPHONE: (424) -301-3063
Silva Garibyan	TELEPHONE: (424) 301-3062
	DATE: 11/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2024

LIC809 (FAS) - (06/04)

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