197419636-9-6-2022-58-CC-SORS-CHZU6W-20220906151901

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197419636
Report Date: 09/06/2022
Date Signed: 09/06/2022 03:19:28 PM

Document Has Been Signed on 09/06/2022 03:19 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:	NETAN ELI HEBREW ACADEMY		FACILITY NUMBER:	197419636
ADMINISTRATOR:	FAHIMEH KASHANI		FACILITY TYPE:	850
ADDRESS:	18043 TOPHAM STREET		TELEPHONE:	(818) 345-6090
CITY:	ENCINO	STATE: CA	ZIP CODE:	91316
CAPACITY:	37	CENSUS: 12	DATE:	09/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:53 AM
MET WITH:	Sara Neydavoud - Assistant Director		TIME COMPLETED:	03:30 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 09/06/2022, Licensing Program Analyst (LPA) Suzette Ornelas, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Assistant Director, Jennifer Quick, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Thursday from 8:30a to 3p and Fridays from 8:30a to 1p. LPA toured and inspected the facility in accordance with the facility sketch. LPA observed 12 children on the premises and 2 teachers who were background cleared in classroom 1. Parents sign children in and out via sign in sheet, however, assistant director was unable to provide LPA with proof of current sign in/out sheet. Teacher/child ratios are maintained, and adequate supervision is being provided. Current facility sketch reviewed and Licensee confirmed that there are 3 licensed classrooms at the facility; however, only one classroom is currently being used. The children’s restroom is located in the far left at the end of the hallway and consists of 3 toilets, 1 changing table and 2 sinks. The facility has sufficient cots or mats for napping. Each mat or cot is occupied by only one child at time. Per Assistant Director, an empty classroom or the office area is used as an "Isolation Area/Room" for sick children. 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 by ensuring they are on a high shelf or stored away in the inaccessible kitchen area. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

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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Document Has Been Signed on 09/06/2022 03:19 PM - 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: NETAN ELI HEBREW ACADEMY	FACILITY NUMBER: 197419636
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

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 interview record review, the licensee did not comply with the section cited above in 3 staff to be missing current immunizaion records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2022
	Plan of Correction
1 2 3 4	Proof of completion will be provided to LPA via email by 09/20/2022.

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation interview record review, the licensee did not comply with the section cited above in 1 staff missing LIC503 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2022
	Plan of Correction
1 2 3 4	Proof of completion will be provided to LPA via email by 09/20/2022.

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

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: NETAN ELI HEBREW ACADEMY	FACILITY NUMBER: 197419636
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101220(a)

Child's Medical Assessments

(a) Prior to, or within 30 calendar days following the enrollment of a child, the licensee shall obtain a written medical assessment of the child. This medical assessment enables the licensee to assess whether the center can provide necessary health-related services to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation interview record review, the licensee did not comply with the section cited above in 6 children to be mising the physicians report which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2022
	Plan of Correction
1 2 3 4	Proof of completion will be provided to LPA via email by 09/20/2022.

Type B

Section Cited

CCR

101220.1(g)

Immunizations

(g) The licensee shall document each child's immunizations and shall maintain such documentation in the center for as long as the child is enrolled. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation interview record review, the licensee did not comply with the section cited above in 5 children to be missing Immunization records which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2022
	Plan of Correction
1 2 3 4	Proof of completion will be provided to LPA via email by 09/20/2022.

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/06/2022 03:19 PM - 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: NETAN ELI HEBREW ACADEMY	FACILITY NUMBER: 197419636
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101221(b)(8)(C)

Child's Records

(C) A signed consent form for emergency medical treatment unless the child's authorized representative has signed the statement specified in Section 101220(f). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation interview record review, the licensee did not comply with the section cited above in 3 children to be missing LIC627A CFEMT which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2022
	Plan of Correction
1 2 3 4	Proof of completion will be provided to LPA via email by 09/20/2022.

Type B

Section Cited

CCR

101223(b)(1)

Personal Rights

(1) The center shall give each authorized representative a copy of the Personal Rights form (LIC 613A [9/96]). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation interview record review, the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2022
	Plan of Correction
1 2 3 4	Proof of completion will be provided to LPA via email by 09/20/2022.

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/06/2022 03:19 PM - 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: NETAN ELI HEBREW ACADEMY	FACILITY NUMBER: 197419636
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229.1(a)

Sign In and Sign Out

(a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation interview record review, the licensee did not comply with the section cited above innone of the children preent were signed in, and there was no current sign in/out sheet available which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 09/20/2022
	Plan of Correction
1 2 3 4	Assistant diector will ensure a meeting is held with staff to ensure that all the children are being properly signed in/out daily. Proof of completion will be provided to LPA via email by 09/20/2022.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

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: NETAN ELI HEBREW ACADEMY	FACILITY NUMBER: 197419636
	VISIT DATE: 09/06/2022

NARRATIVE

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All toilets and handwashing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Per assistant director, the facility provides daily meals for the children. The weekly daily snack menu remains the same throughout the entire school year.

Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA reminded director to ensure all the outdoor equipment is regularly inspected and dusted off as needed. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors located in the kitchen, smoke detector located in the hallway and fire extinguishers (2A 10 BC) located in both the hallway and the kitchen that meet statutory requirements. LPA provided director with a copy of the Disaster and Mass Casualty Plan regulation and information on ensuring the plan follows requirements, which is to be maintained at the facility moving forward. Due to school year beginning on 09/01/2022, a n Emergency drill has yet to be conducted. LPA provided assistant director with a copy of an emergency disaster drill log sample. Per Assistant Director, a drill will be conducted and proof of completion will be sent to LPA via email.

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. No individuals excluded by the Department are allowed to be present. Capacity and limitations as specified on the license are being maintained. 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 children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child. LPA observed 6 children to be missing the Physicians report, 5 children to be missing immunization records, 3 children to be missing LIC627A CFEMT, 2 children to be missing LIC613. LPA reviewed a sample of staff files and observed 3 files were incomplete with documentation of meeting qualification requirements, immunization records for influenza, pertussis and measles. Proof of documentation will be submitted via email. Mandated Reporter training certificate was missing for all staff. Assistant director was provided with a copy of the regulation and will ensure proof of completion is submitted to LPA via email. All other mandatory documentation was observed to be in all staff files.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

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: NETAN ELI HEBREW ACADEMY	FACILITY NUMBER: 197419636
	VISIT DATE: 09/06/2022

NARRATIVE

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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, type B deficiencies are being cited today:

Staff Records - Type B: 1596.7995(a)(1)
Staff Records - Type B: 101216(g)(1)
Children Records - Type B: 101220(a)
Children Records - Type B: 101220.1(g)
Children Records - Type B: 101221(b)(8)(C)
Children Records - Type B: 101223(b)(1)
Children Records - Type B: 101229.1(a)

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 Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC809 (FAS) - (06/04)

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