304371070-5-24-2022-06-CC-RLOZ-CEZR5X-20220602124349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 304371070
Report Date: 05/24/2022
Date Signed: 05/24/2022 03:34:27 PM

Unsubstantiated

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-20220303152442

FACILITY NAME:	TEMPLE BETH SHOLOM EARLY CHILDHOOD CENTER		FACILITY NUMBER:	304371070
ADMINISTRATOR:	LEVIN, TAMARA		FACILITY TYPE:	830
ADDRESS:	2625 NORTH TUSTIN AVENUE		TELEPHONE:	(714) 628-4640
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY:	24	CENSUS: 14	DATE:	05/24/2022
		UNANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Tamara Levin, Director		TIME COMPLETED:	03:30 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 finding 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 4 infants and 1 staff in room #1 and 10 infants in room #6 with 3 staff.
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 the classroom for the infants/toddlers has had one teacher and 5 or more infants for that one teacher in the last two weeks.
(Continue next page)

Unsubstantiated

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)

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Control Number 06-CC-20220303152442

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 EARLY CHILDHOOD CENTER	FACILITY NUMBER: 304371070
	VISIT DATE: 05/24/2022

NARRATIVE

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(Page 2 of Report)

During the investigation, LPA interviewed 5 staff members and Director, reviewed facility roster, children and staff files, staff’s schedules, 14 staff’s timecard out of 14 staff and payroll information.

On 03/09/2022, LPA Tran conducted an initial 10-day inspection and toured the entire facility. During the tour, LPM Tran observed 9 infants with 3 staff members in classroom #1, and 9 infants with 3 staff in classroom # 6. Facility was operating within its capacity and met staffing ratio on this date.

During the staff interviews, all 5 interviewed staff denied working alone with more than 4 infants.

During record review, staff schedules showed that there were 3 staff working during the reporting period from 02/21/2022 to 03/04/2022. It was discovered during record review and through director’s disclosure to LPA Tran that one staff who was scheduled to work did not clock in on 03/07/2022 and another staff did not clock in on 03/08/2022 due to their missing timecards. Time cards that were provided by the facility payroll department did not show the two staff clocking in and out on the 03/07/2022 and on 03/08/2022, however, there are writing notes that staff worked on those days. Director also informed LPA Tran that staff did not stay working in one classroom as Director would move staff to different classrooms to provide coverage.

Based on the information gathered from LPA’s interviews and records review, there is insufficient evidence to corroborate the allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged of facility is operating out of ratio, did or did not occur, therefore the listed allegation is UNSUBSTANTIATED.

Appeal Rights 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.

(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)

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