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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494327
Report Date: 11/08/2021
Date Signed: 11/08/2021 10:03:54 AM

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:EMUNAH HEBREW ACADEMYFACILITY NUMBER:
197494327
ADMINISTRATOR:MOJGAN (SARA) YASHARPOURFACILITY TYPE:
850
ADDRESS:1518 S ROBERTSON BLVDTELEPHONE:
(310) 777-7888
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY:100CENSUS: 0DATE:
11/08/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yasharpour "Sara" MojganTIME COMPLETED:
10:10 AM
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On 11/08/2021 at 9:00 am Licensing Program Analyst (LPA), Deborah Lowe met with Emunah Hebrew Academy Director Yasharpour "Sara" Mojgan at the El Segundo Child Care Regional Office to review Outdoor Activity Waiver request in relation to the facility application for a capacity increase.

LPA Lowe reviewed with Director the individual outdoor schedules along with the individual classroom schedules the Director provided to LPA on 11/05/2021. LPA and Director discussed discrepancies in the schedules provided, discussed how can be corrected.

LPA Lowe made copies of notes discussed during meeting and provided to Director. Director will make corrections to schedules and email corrected schedules to LPA Lowe.

During meeting LPA Lowe reviewed with Director Sara the Guardian Background Check system along with facility association list for background clearances. Licensee was reminded that all adults 18 and over, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA Lowe provided Director with a blank copies of LIC 9182 Criminal Background Clearance Transfer Request form and LIC 508 Criminal Record Statement. LPA Lowe advised Director to include a clear copy of drivers license.

Exit interview with Director Yasharpour "Sara" Mojgan and a copy of this report was provided.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah LoweTELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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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