304371159-7-11-2019-06-CC-JMHN-BDYKBV-20190711074606

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304371159
Report Date: 07/10/2019
Date Signed: 07/11/2019 07:46:16 AM

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:	OLAM JEWISH MONTESSORI OF BETH JACOB		FACILITY NUMBER:	304371159
ADMINISTRATOR:	KREISBERG, DAWN		FACILITY TYPE:	830
ADDRESS:	3880 MICHELSON		TELEPHONE:	(949) 786-5230
CITY:	IRVINE	STATE: CA	ZIP CODE:	92612
CAPACITY:	8	CENSUS: 6	DATE:	07/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Dawn Kreisberg		TIME COMPLETED:	05:45 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	Licensing Program Analyst (LPA), Han conducted an unannounced annual/random inspection of the facility on today's date. LPA Han toured the facility with the director, Dawn Kreisberg inside and outside. Census was taken in individual classrooms. The overall census observed was 3 infant staff and 6 infants. A review of staff criminal clearance 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. Operating hours are 8:00 am- 6:00 pm, Mon-Fri. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. The items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. Snacks are provided on site. Food prep areas appear clean and sanitary. Food is properly stored. On site kitchen is free from hazards. The toys, floors, desks and other equipment appeared clean. There is drinking water available to children both indoors and outdoors. The children's bathrooms are clean and sanitary. Children nap on cribs. Per staff #2, bedding is taken home weekly to be washed by parents. The facility has conducted an emergency drill within the past six months. The facility has a working smoke detector and fire extinguisher. Carbon monoxide detector was not available to review during the inspection. The playground was completely fenced. The playground equipment appeared in safe condition. Sign in/out procedure was reviewed for compliance. LPA observed two parents did not sign out on 7/9/2019. During today's visit staffing ratios were being met. At least one staff member present possesses current CPR/First Aid certifications, which expires 5/18/2021. Children's and staff files were reviewed for compliance. Staff#1 and staff#3 did not complete mandated reporter training. Staff#1,#2, #3 did not have complete required immunization records, Health screening reports, and TB test in staff file.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

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: OLAM JEWISH MONTESSORI OF BETH JACOB	FACILITY NUMBER: 304371159
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.8662.(b)(1)

Staff Records

1596.8662.(b)(1)… mandated reporter…proof of completion ...January 1, 2018, is a licensed child care provider..shall complete the mandated reporter training provided...renewal mandated reporter training every two years...This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, director failed to ensure to maintain mandated reporter training certificates for staff#1 and staff#3. This poses a potential Safety risk to the children in care.
	POC Due Date: 08/10/2019
	Plan of Correction
1 2 3 4	Director will submit mandated reporter training certificates for staff#1 and Staff#3 by email by due date. JUNGMI.HAN@DSS.CA.GOV

Type B

Section Cited

CCR

101229.1(a)(1)

Children Records

101229.1(a)(1) (a) In addition to the sign-in procedure requirement of Section 101226.1(b), the licensee shall develop, maintain and implement a written procedure to sign the child in/out of the child care center that shall, at a minimum, include the following: (1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
	Deficient Practice Statement
1 2 3 4	Based on record review, director failed to ensure to maintain full signaure on sign in and out sheet. This poses a potential Safety risk to the children in care.
	POC Due Date: 08/10/2019
	Plan of Correction
1 2 3 4	The director will submit proof of correction (LIC 9098) by due date by email. JUNGMI.HAN@DSS.CA.GOV

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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: OLAM JEWISH MONTESSORI OF BETH JACOB	FACILITY NUMBER: 304371159
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.954

Physical Plant - Licensure Requirements

Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.
	Deficient Practice Statement
1 2 3 4	Base on observation and interview, director failed to ensure to maintain working carbon monoxide detector in the facility. This poses a potential Health and Safety risk to the children in care
	POC Due Date: 08/10/2019
	Plan of Correction
1 2 3 4	Director will submit proof by email by due date. JUNGMI.HAN@DSS.CA.GOV

Type B

Section Cited

HSC

1596.7995(a)(1)

Staff Records - General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
	Deficient Practice Statement
1 2 3 4	Based on record review, director failed to ensure to maintain staff's required immunization records in staff file. This poses a potential Health and Safety risk to the children in care
	POC Due Date: 08/10/2019
	Plan of Correction
1 2 3 4	Director will submit three staff's immunization records by email by due date.

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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

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: OLAM JEWISH MONTESSORI OF BETH JACOB	FACILITY NUMBER: 304371159
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/10/2019

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(c)(1)(A)

Staff Records - Personnel Records

(c) All personnel records shall be available to the Department to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: (1) Licensing representatives shall not remove the following current records for current personnel unless the same information is otherwise readily available in another document or format. (A) Health-screening records and results of tuberculosis tests as specified in Section 101216(g).
	Deficient Practice Statement
1 2 3 4	Based on record review, director failed to ensure to maintain staff health-screening report and TB test result in staff file. This poses a potential Health and Safety risk to the children in care
	POC Due Date: 08/10/2019
	Plan of Correction
1 2 3 4	Director will submit 3 staff's LIC 503 by email by due date. JUNGMI.HAN@DSS.CA.GOV

Type B

Section Cited

CCR

101439.1(e)(1)

Care and Supervision

101439.1 Infant Care Center Napping Equipment (e) Each infant's bedding shall be used for him/her only. Such bedding shall be replaced when wet or soiled, or when the crib, mat or cot is to be occupied by another infant. (1) Bedding shall be changed daily, or more often if required by (e) above.
	Deficient Practice Statement
1 2 3 4	Base on interview with staff#2, the parents are taking infant's bedding weekly basis. This poses a potential Health and Safety risk to the children in care
	POC Due Date: 08/10/2019
	Plan of Correction
1 2 3 4	Director will submit the updated parent's book that includes bedding policy. Director will submit it by email by due date.

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: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

Page: 3 of 7

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: OLAM JEWISH MONTESSORI OF BETH JACOB	FACILITY NUMBER: 304371159
	VISIT DATE: 07/10/2019

NARRATIVE

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The facility does not provide Incident Medical Services.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on LPAs observations, record reviews, and interviews the following violations were observed are being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101217(c)(1)(A), 101229.1(a)(1), 101439.1(e)(1) and Health and Safety 1596.8662(b)(1), 1596.7995(a)(1), 1596.954. Please refer to attached 809D for documentation of deficiencies.

Facility was advised on how to receive notifications for quarterly updates and provided with Child Care Advocate contact information: childcareadvocatesprogram@dss.ca.gov.

A copy of the 2016 “A Child Care Providers Guild to Safe Sleep” was provided to the facility representative.
English: https//www.cdph.ca.gov/programs/SIDS/Documents/SIDSchildcaresafesleep.pdf
Spanish: https//www.cdph.ca.gov/programs/SIDS/Documents/ChildCareProvSleepSPAN2011.pdf
AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx
NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative
Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials
Always place infants on their backs for sleeping
Use only a tight-fitting sheet on the crib or play yard mattress
Do not hang any items from the crib or above the crib
Keep all items, including blankets, out of the crib or play yard
Pacifiers may be used as long as they do not have items attached to them
Infants should not be swaddled or have any items covering them while sleeping
The temperature of the room should be comfortable enough for an adult to wear a t-shirt and not be too hot or too cold

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

Page: 6 of 7

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: OLAM JEWISH MONTESSORI OF BETH JACOB	FACILITY NUMBER: 304371159
	VISIT DATE: 07/10/2019

NARRATIVE

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Provided was information about the E-Learning Modules available at https://ccld.childcarevideos.org

The facility representative was informed that the CRIMINAL RECORD STATEMENT (LIC 508) has been updated, and the facility must now use the new form with revised date 7/15. The facility representative was also informed that the LIC 508 must be submitted with all Criminal Background Clearance Transfer Request (LIC9182). The facility representative was informed that Licensing Updates are available at www.ccld.ca.gov

Documents/Information to be updated and returned to the Licensing Office;
- Personnel Report (LIC 500)
- Emergency Disaster Plan (LIC 610)
- Designation of Administrative Responsibility (LIC 308)
- Administrative Organization (LIC 309)

Exit interview was conducted. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Appeal Rights and deficiencies were discussed. The director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. Licensee was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov

The director was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.

SUPERVISOR'S NAME: Judy Hanson	TELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Jung Mi Han	TELEPHONE: (714) 703-2819
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019

LIC809 (FAS) - (06/04)

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