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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561708073
Report Date: 11/07/2023
Date Signed: 11/07/2023 12:37:11 PM


Document Has Been Signed on 11/07/2023 12:37 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
SANTA BARBARA CC RO, 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:210CENSUS: DATE:
11/07/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Debbie BlumenthalTIME COMPLETED:
12:50 PM
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On November 7, 2023 Licensing Program Analysts (LPA's) Susana Martinez and Veronica Diaz conducted an unannounced case management- licensee initiated inspection to deliver a waiver. LPA's met with Site Director Debbie Blumenthal and advised her for the purpose of the inspection. Together with the director, LPA's toured the facility inside and outside.

The center requested a waiver to allow armed guards on campus. In accordance with Section 101175(b), the waiver is granted. The waiver is valid for the term of the license and is subject to review at the discretion of the licensing agency.
We are granting the waiver under the following conditions:
- The individual carrying the weapon must be employed by a licensed private patrol operator
or private security employer.
- The individual must possess a valid firearms qualification card issued by the California
Department of Consumer Affairs, Bureau of Security and Investigative Services. (also
referred to as a “Firearms Qualification Card (FQ) or “Exposed Firearms Permit”).
- The firearm must remain on the individual’s person, retained in a holster which has a
retention level no lower than level three (3).
- The individual carrying the firearm must undergo and clear a background check by the
Community Care Licensing Division prior to employment or stationing at the facility.
- The licensee must report any changes in armed guard(s) to the Department within 10
working days.
- The licensee must maintain and make available for review at the childcare center, a copy of
this written approval waiver letter.
-This waiver is not transferable to any other party or entity.

Continued on 809-C
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: TEMPLE ETZ CHAIM PRESCHOOL
FACILITY NUMBER: 561708073
VISIT DATE: 11/07/2023
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The waiver is granted at the discretion of the licensing agency and is subject to review. Failure
to comply with the above conditions may result in termination of this waiver and/or deficiency
citations. A copy of this document must be posted with your facility license.

If you have any questions with regards to this waiver, please contact the office at
(805) 562-0400.

The waiver shall be posted at all times.

Notice of site visit was given.

Exit interview conducted and report reviewed with Director Debbie Blumenthal.
SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC809 (FAS) - (06/04)
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