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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561708073
Report Date: 05/26/2021
Date Signed: 05/28/2021 04:09:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:TEMPLE ETZ CHAIM PRESCHOOLFACILITY NUMBER:
561708073
ADMINISTRATOR:DEBBIE BLUMENTHALFACILITY TYPE:
850
ADDRESS:1080 JANSS ROADTELEPHONE:
(805) 497-6852
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:171CENSUS: 145DATE:
05/26/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Debbie BloomenthalTIME COMPLETED:
12:00 PM
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On May 26, 2021 at 11AM, Licensing Program Analysts (LPA) Michael Avila conducted an announced tele-visit Case Management inspection. Due to COVID-19 and Department of Public Health (DPH) guidelines of social distancing, a tele-inspection will occur. LPA met with Director Debbie Bloomenthal through FaceTime and was conducted a tour of the facility.

Facility submitted an application to the Community Care Licensing (CCL) requesting an increase in capacity for their preschool license to 210 children to include a toddler component of 36 children. The facility has 14 classrooms for the children in care. On May 6, 2021 the Ventura County Fire Department inspector conducted a fire inspection. The facility received a fire clearance approval for the increase in capacity for 210.

Classroom measurements of the 14 classroom and outdoor space along with sinks and toilets can accommodate the capacity increase of 210 children.

The center meets Title 22 Division 12 requirements.

License capacity increase will be effective today, May 26, 2021 for 210 children to include a toddler component of 36 children.

A copy of this report was reviewed and provided to the facility. Director agreed to receive a copy of report via email and voiced understanding that the read receipt confirmation from email will be in lieu of their signature once she received the report. LPA requested licensee to email a copy of signed form for records.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.

SUPERVISOR'S NAME: George MingleTELEPHONE: (805) 562-0410
LICENSING EVALUATOR NAME: Michael AvilaTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
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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