300600959-10-5-2019-06-CC-JMHN-BGNUYM-20191005160009

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300600959
Report Date: 10/04/2019
Date Signed: 10/05/2019 04:00:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	TEMPLE BETH SHOLOM CHILDREN'S LEARNING CENTER		FACILITY NUMBER:	300600959
ADMINISTRATOR:	LEVIN, TAMARA		FACILITY TYPE:	850
ADDRESS:	2625 N TUSTIN		TELEPHONE:	(714) 628-4640
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY:	60	CENSUS: 19	DATE:	10/04/2019
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Tamara Levin - Director		TIME COMPLETED:	02:30 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	A case management inspection was conducted today by Licensing Program Analyst (LPA) Jungmi (Jamie) Han conducted an inspection at the facility for the purpose of adding rooms without capacity increase. The facility is currently using three rooms (room#2, #3, #4) and adding three more rooms for preschool children: room#7, room#8, room#11. Director stated room#11 is going to use during preschool children's nap time. Teachers will be able to clean and prep the classroom while children are taking nap in room#11. Preschool children’s capacity remains same as current 60. Fire clearance was approved on 10/3/2019 for 60 preschool children in room#2, room#3, room#4, room#7, room#8, and room#11 with special condition, clearance granted pending documentation from school’s architect/engineer. Orange County Fire Authority (OCFA) did not allow the facility to increase capacity until the facility submits pending documentation from school’s architect/engineer. OCFA approved for adding rooms without increase capacity. The facility also has infant license #304371070. Infants are using room#1 and room#6 with total capacity 24. LPA met with licensee, Tamara Levin. LPA Han toured the facility inside and outside. Census was taken. There was a total of 19 preschool children with 5 preschool staff observed. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA Han toured the entire facility indoors & outdoors and the following measurements were taken: Indoor: Room #2: 775.6828 div. 35 = 22.16 Room #3: 775.6828 div. 35 = 22.16 Room #4: 775.6828 div. 35 = 22.16 Room #7: 775.6828 div. 35 = 22.16 Room #8: 810.342 div. 35 = 23.15 Room #11: 857.712 div. 35 = 24.50

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TEMPLE BETH SHOLOM CHILDREN'S LEARNING CENTER	FACILITY NUMBER: 300600959
	VISIT DATE: 10/04/2019

NARRATIVE

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Total indoor space= 4770.787 div 35 = 136 children

Total children toilets and sinks:

8 toilets x 15 children = 120
(room#2,3,4=1 toilet each, room#7,8=2 toilets each, room#11= 0 toilet, outdoor=1 toilet)
16 sinks x 15 children = 240
(room#2,3,4 = 2 sinks each, room#7,8 = 4 sinks each, room#11 = 1 sink, outdoor = 1 sink)

Outdoor:
8750 square feet/ 75= 116 children

Fire clearance from the Irvine Fire Department has been received and approved for requested capacity of 60 children.
Based on today’s measurement and the sink & toilet availability, center has sufficient activity space to support the requested capacity of 60 preschool children.

The following was observed:
· Classroom are adequately equipped with age and size appropriate furniture and equipment
· Drinking water is available for inside and outside drink.
· Playground is fully enclosed by an appropriate fence.
· Outdoor activity area is supplied with age and size appropriate equipment.
· Snacks are provided by the facility and lunch is brought by each child
· The director’s office will serve as the isolation area for ill children until parents arrive.
· A separate staff restroom is available next to the infant room#1.
· Medication will be stored in each classroom in a locked cabinet
· Sign in/Sign out procedure was reviewed and meets regulation requirements
· There is a working smoke detector and fire extinguisher that meet statutory requirements. There are carbon monoxide detectors in room#2, room#3, room#4, room#7, room#8, and room#11.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TEMPLE BETH SHOLOM CHILDREN'S LEARNING CENTER	FACILITY NUMBER: 300600959
	VISIT DATE: 10/04/2019

NARRATIVE

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Director was reminded about Teacher-Child ratio requirements, direct visual supervision requirements, emergency/disaster drills, posting requirements, children records, mandated child abuse and injury/ death reporting, mandated reporter training, immunization requirements against measles, pertussis, and influenza and fingerprint clearance requirements.

Licensee will submit proofs via email of the corrections to be completed to LPA within 30 days of today’s date. LPA informed applicant that a final review of the file will be done before the license is issued. The licensee will be notified if any corrections or additions still need to be completed.
Exit interview was conducted, and report was reviewed and discussed. Notice of Site Visit was posted during the visit. The facility representative was informed that the Notice of Site Visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100 per day. The licensee was provided a copy of their appeal rights (LIC 9058 1/16) and their signature on this form acknowledges receipt of these rights. First level appeal is to Regional manager, address is above on the report. The facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov. This report is to be on file and accessible for public review at the facility for at least 3 years.

SUPERVISOR'S NAME: Patricia Magana	TELEPHONE: (714) 703-2821
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 309-7211
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2019

LIC809 (FAS) - (06/04)

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