561708073-11-16-2021-17-CC-FPEA-C8U2QZ-20211116163645

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 561708073
Report Date: 11/16/2021
Date Signed: 11/16/2021 04:36:52 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 PRESCHOOL		FACILITY NUMBER:	561708073
ADMINISTRATOR:	DEBBIE BLUMENTHAL		FACILITY TYPE:	850
ADDRESS:	1080 JANSS ROAD		TELEPHONE:	(805) 497-6852
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	210	CENSUS: 131	DATE:	11/16/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Debbie Blumenthal		TIME COMPLETED:	04:50 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	On November 16, 2021 at 11:40 AM, Licensing Program Analysts (LPAs) Francisco Pedroza and Dean Thompson conducted an unannounced Annual/Random inspection. LPAs met with facility Director Debbie Blumenthal and advised the purpose of the inspection. Director Provided LPAs a tour of the facility inside and out. There were 131 children in care at the time of the inspection. LPAs observed required licensing documents mounted on the wall in each classroom. LPAs observed the center snack schedule. The center provides two (2) snacks daily for children. Children bring their own lunch from home. The center has 14 classrooms available for use. LPAs observed each classroom shared a bathroom in the center with the adjacent classroom for children in care. LPAs did not observe any hazards/toxins items accessible to children in care. Each of the classrooms have age appropriate toys and furniture readily accessible for children in care. Facility provides children that are staying full day a sleeping mat during quiet time if they choose to sleep. The outdoor playground has an ample amount of space for children to play. LPAs observed the playground has age appropriate toys and structures available for children to use. The playground has ample amount of shade available. The facility has water available for children inside and out. Children use their own water bottles. A sampling of children and staff records were reviewed. LPAs observed children's files to be complete and current. Currently the facility does have children that require Incident Medical services (IMS). LPAs observed staff files to be complete and current. LPAs verified SB792 Child Care Adult Immunization and Tuberculosis requirements. Teachers meet the required qualifications. Teachers present have current Pediatric CPR/First-Aid certificates that are valid until 2/12/2023. Teachers have current Mandated Reporter certificates that are valid until 3/14/2023. LPAs spoke with Director about new Covid-19 guidelines. Facility is currently following Covid-19 guidelines. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 PRESCHOOL	FACILITY NUMBER: 561708073
	VISIT DATE: 11/16/2021

NARRATIVE

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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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.html
No deficiencies were cited during today's inspection.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee [or facility representative] and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Francisco Pedroza	TELEPHONE: (805) 689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2021

LIC809 (FAS) - (06/04)

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