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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197419024
Report Date: 05/24/2019
Date Signed: 05/24/2019 04:26:11 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/17/2019 and conducted by Evaluator Silva Garibyan
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20190517165410
FACILITY NAME:ADAT ARI EL NURSERY SCHOOLFACILITY NUMBER:
197419024
ADMINISTRATOR:ZADOK, ORIFACILITY TYPE:
830
ADDRESS:12020 BURBANK BOULEVARDTELEPHONE:
(818) 766-6379
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:35CENSUS: 20DATE:
05/24/2019
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ori ZadokTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Physical Plant: The carpets are dirty with babies on the floor all the time
INVESTIGATION FINDINGS:
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Silva Garibyan, Licensing Program Analyst (LPA) conducted an unannounced complaint investigation inspection to the licensed facility.. Upon arrival, LPA met with Ori Zadok, Center Director. LPA explained the purpose of the inspection. There were 20 infants and 7 teachers present at the time of the visit. LPA toured the facility with Ori Zadok, Center Director at 12:30.Based on the information obtained from the interviews conducted and observations by the LPA, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 07, Section 101238.3 (b) is being cited on the attached LIC 9099D page. Appeal rights were discussed and printed. Copy of this report was provided, Notice of Site visit issued.
Exit interview was conducted.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 30-CC-20190517165410
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: ADAT ARI EL NURSERY SCHOOL
FACILITY NUMBER: 197419024
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/07/2019
Section Cited
CCR
101238.3(b)
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The floors of all rooms shall have a surface that is safe and clean.
This requirement is not met as evidenced by: LPA observed stains on the carpet in the infant activity room.
This is a type B dificiency as poses a potential risk to the health and safety of children in care
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Deep shampoo to remove the stains or replace the carpet on or before 06/07/2019. Notify Community Care Licensing by submitting LIC 9098 with attached picture. proof the correction was done.
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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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 2