300600959-5-24-2022-06-CC-RLOZ-CEZSNN-20220602140150

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300600959
Report Date: 05/24/2022
Date Signed: 05/24/2022 05:21:06 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/03/2022 and conducted by Evaluator Nguyen K Tran

PUBLIC

COMPLAINT CONTROL NUMBER: 06-CC-20220303151326

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: 44	DATE:	05/24/2022
		UNANNOUNCED	TIME BEGAN:	03:39 PM
MET WITH:	Tamara Levin, Director		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility is operating out of ratio.

INVESTIGATION FINDINGS:

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On 05/24/2022, Licensing Program Analyst (LPA) Tran conducted a in person inspection to deliver the findings regarding the above complaint allegation. LPA Tran met with Director Tamara Levin. The Covid-19 Emergency Response questionnaires were asked. A tour the facility was conducted, and a census was taken. Observed at the time of the visit was a total of 19 preschool children with 3 staff in classroom #3 during naptime, 14 preschool children and 1 staff in classroom #4 during naptime, and 11 preschool children and 1 staff in classroom # 7.
A review of the Facility Personnel Report Summary on 05/24/2022 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.
On 03/03/2022, the office received a complaint alleging, facility is operating out of ratio. Reporting Party (RP) stated that the facility is short staffed. RP stated that a classroom has 15 children with one teacher and another classroom has 12 children with one aide.
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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022

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 4

Control Number 06-CC-20220303151326

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/24/2022

NARRATIVE

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(Page 2 of Report)

During the investigation, LPA interviewed 5 staff members including director, reviewed facility staff and children roster, children and staff files, staff’s schedules, 14 staff’s timecards of 14 staffs and payroll information.

On 03/09/2022, LPA Tran conducted an initial 10-day inspection and toured the entire facility. During the tour, LPA Tran observed 7 preschool children with 2 staff members in classroom #2, 11 preschool children with 2 staff members in classroom #3, 12 preschool children with 2 staff members in classroom # 4, and 13 preschool children with 2 staff members in classroom #7. Facility was operating within its capacity and met staffing ratio on this date.

During the staff interviews, all 4 interviewed staff confirmed that they have worked alone with more than 12 children on different occasions and when other staff went on breaks for 10 minutes and at lunch time ranging from 30 minutes to one hour. When asked if a staff ever worked alone with more than 12 children, Director admitted that sometimes, emergency happened, and staff would be working by themselves for a short period of time, average 10 minutes, with more than 12 children. Director explained there is a door in between the classrooms and staff can leave that door open so the teachers in the next classroom can assist to provide supervision.
Staff #2 (S2) said S2 worked alone with more than 12 children a few days in 2021 but could not specify the dates.
Staff #3 (S3), confirmed that S3 worked alone with 13-14 children on Tuesdays between 2pm-4pm. On multiple occasions, when called Director to ask for a break, S3 was told to take a 10-minutes break leaving one staff with more than 12 children in the morning and in the afternoon if needed.
Staff #4 (S4), confirmed that S4 has worked alone with more than 12 children on different occasions. On 02/14/22 with 14-15 children, and on 01/25/22 with 14 children from 8am-4pm, when S4 asked for help, the Director only came to assist for 5 minutes.
Staff #5 (S5) confirmed that she worked alone on 10/22/2021 with more than 12 children; and on 03/07/22, S5 worked alone with 15 children, 2 children were picked up at 1pm; S5 worked with 13 children from 1pm-5pm.

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SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 06-CC-20220303151326

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/24/2022

NARRATIVE

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(Page 3 of Report)

During record review, LPA Tran could not determine if staff was left working alone as director inform LPA Tran 2 of the staff who were scheduled to work did not clock in due to their timecards were missing. Director also informed LPA Tran that staff did not stay to work in one classroom as Director would move staff to different classrooms to provide coverage as needed.

Based on the information LPA gathered from the interviews with 4 staff, the preponderance of evidence standard has been met, therefore the above allegation of facility operating out-of-ratio in the preschool classrooms is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 & Chapter 1, 101216.3 (a) Teacher-Child Ratio is being cited on the attached LIC9099-D.

Appeal Rights and deficiency were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Tamara Levin.

Due to the Type A violation cited today, the Director shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day, and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the Director shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The Director is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00

(End of Report)

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 06-CC-20220303151326

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/24/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/31/2022 Section Cited CCR 101216.3(a)	1 2 3 4 5 6 7	101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Director stated that a detailed plan to address staffing schedule and ensure teacher-child ratio being met at all time, will be submitted to LPA Tran via email by 05/31/2022.
	8 9 10 11 12 13 14	Based on staff interviews, S2, S3, S4 and S5 confirmed that they have worked alone with more than 12 children on different occasions. This poses an immediate risk to the safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rina Lopez	TELEPHONE: (714) 795-0859
LICENSING EVALUATOR NAME: Nguyen K Tran	TELEPHONE: (714) 658-6048
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022

LIC9099 (FAS) - (06/04)

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