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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494327
Report Date: 03/21/2023
Date Signed: 03/21/2023 06:53:48 PM


Document Has Been Signed on 03/21/2023 06:53 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: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:117CENSUS: 68DATE:
03/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Mojgan Sara YasharpourTIME COMPLETED:
01:30 PM
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On 3/21/2023 Licensing Program Analyst (LPA) Judy Laureano conducted an unannounced Case Management – Incident inspection related to a self-reported Unusual Incident Report (UIR) submitted on 3/6/2023.

Upon arrival, LPA met with Director, Sara Yasharpour, and explained the purpose of the visit. LPA observed 68 children in care supervised by 14 staff.

According to the UIR, on 3/3/2023 Child 1 (C1) was pushing himself on the table and swinging his feet while leaning between the table and cubby in room 301. He lost his balance and fell on his tummy and landed on his face damaging his two front teeth.

Teacher washed child's mouth and collected the pieces of his teeth and took him to the office. Secretary called mom to have him picked up. Facility advised family to take child to a dentist for medical attention.

During today’s inspection, LPA toured the indoor and outdoor of the facility and interviewed Director, teacher and children. LPA received a copy of the children’s roster for review.

At this time, further investigation is needed.

An exit interview was conducted. A copy of this report (LIC 809) and Notice of Site Visit were provided to Director, Sara Yasharpour

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2023
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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