561708073-8-17-2023-17-CC-SMAZ-CUSU9Y-20230817152355

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 561708073
Report Date: 08/17/2023
Date Signed: 08/17/2023 03:24:02 PM

Document Has Been Signed on 08/17/2023 03:24 PM - It Cannot Be Edited

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: 106	DATE:	08/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Debbie Blumenthal		TIME COMPLETED:	03:38 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 August 17, 2023 Licensing Program Analyst (LPA) Susana Martinez conducted an unannounced Required- 1 Year and change of capacity inspection. LPA met with site director Debbie Blumenthal and advised her of the purpose for the inspection. Together with the director, LPA toured the facility inside and outside. At the time of inspection there were 106 children in the care of 32 adults. LPA observed required licensing documents mounted on the wall in each classroom. LPA observed the center snack schedule. The center provides two (2) snacks daily for children. Children bring their own lunch from home. LPA observed each classroom shared a bathroom in the center with the adjacent classroom for children in care. LPA 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 a sleeping mat during quiet time if they choose to sleep. The outdoor playground has an ample amount of space for children to play. LPA 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. Last fire drill was observed to be conducted on 04/25/2023. A sampling of children and staff records were reviewed. LPA observed children's files to be complete and current. LPA 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 7/2024. The center submitted an application for an increase of toddlers capacity from 36 to 46 children and to decrease the preschool capacity from 174 to 164. The center is adding Room R for toddlers. LPA observed room R to be fully furnished with age appropriate toys and furniture. No toxins/hazardous items were observed at the time of inspection. Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana Martinez	TELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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: 08/17/2023

NARRATIVE

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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process.

The center meets Title 22 Division 12 requirements for 46 toddlers and 164 preschool children. License will be effective today, 08/17/2023 for total capacity of 210 children.

During the tour, LPA found one staff member (S1) not listed on the facility roster. LPA asked S1 how long she has been working at the facility for, S1 stated she just started on Monday August 14, 2023. LPA asked if a criminal clearance notice had been received, S1 stated yes that the Director should have it. Upon record review it was determined that S1 did not have a criminal record clearance on file. LPA verified through the online background check system, Guardian, that the employee was not fingerprint cleared and no record of S1 was found. At 2:35 PM, LPA observed S1 leave the facility. LPA advised Director that S1 cannot return until fingerprint clearance has been granted.

Director was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

A copy of this report must be provided to the authorized representatives of all currently enrolled children and must also be provided to newly enrolled children for the next 12 months. The report shall be provided no later than the next business day or the next day the child is in care.

The ACKNOWLEDGEMENT OF RECEIPT OF LICENSING REPORTS (LIC 9224) shall be signed and kept in each of the children’s records. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: https://www.cdss.ca.gov/inforesources/child-care-licensing
Continued on 809-C

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana Martinez	TELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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: 08/17/2023

NARRATIVE

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Copies of this report must be posted for 30 days in a visible location for the authorized representatives of children. Notice of Site Visit has been posted (LIC9213). The notice shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and/or Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited:
HSC1596.871(c)(1)(A)

Exit interview conducted with Director Debbie Blumenthal. A copy of the Appeal Rights (LIC 9058 FAS 01/16) were given and explained. Licensee’s signature on this form acknowledges receipt of these rights.

SUPERVISOR'S NAME: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana Martinez	TELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/17/2023 03:24 PM - It Cannot Be Edited

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1596.871(c)(1)(A)

Administration of Child Day Care Licensing

Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in 1 out of 1 staff member which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/17/2023
	Plan of Correction
1 2 3 4	LPA observed S1 leave the facility. LPA advised the Director that S1 cannot return until a fingerprint clearance has been granted,

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: George Mingle	TELEPHONE: (805) 562-0411
LICENSING EVALUATOR NAME: Susana Martinez	TELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC809 (FAS) - (06/04)

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