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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561708073
Report Date: 09/04/2024
Date Signed: 09/04/2024 12:04:45 PM


Document Has Been Signed on 09/04/2024 12:04 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:
09/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Debbie Blumenthal TIME COMPLETED:
12:19 PM
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On September 4, 2024 at 10:46 AM, Licensing Program Analysts (LPAs) Aaliyah Zendejas and Susana Martinez made an unannounced visit for the purpose of conducting a Case Management - Incident inspection. LPAs met with Debbie Blumenthal to discuss an incident that was self reported to Community Care Licensing Division (CCLD) office by phone on 08/28/2024. LPAs toured the play yard area where the incident occurred and interviewed the Director, and staff that were involved in the incident.

On 08/28/2024 an incident occurred at the center at about 11:15 AM. S1 found a child who was left unaccompanied by an adult. S1 then took the child and reunited them with their class and teachers. S1 stated that they had left their class and observed the child standing near a pillar asking where their class was. S1 stated that the child seemed confused but was not crying or scared. Once reunited with their class, the child was fine and playing again. S2 and S3 stated that the child was left unattended for less than five minutes. After the incident occurred, parents were notified of what happened.

The child returned to the facility the next day. To prevent any similar incidents, the licensee has had a meeting with staff to remind them of regulations and staff indicated that they have begun implementing further steps to ensure that children are being accounted for while in the facility.

Given the incident was observed by staff who took appropriate action by immediately reporting to licensing and the parent of the child as well as implementing changes to ensure children are being supervised and accounted for, no deficiencies are being cited as a result of this incident.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.
Appeal Rights were provided to Director Debbie Blumenthal
Exit interview conducted and report was reviewed with the Director Debbie Blumenthal.
SUPERVISOR'S NAME: Lissete GonzalezTELEPHONE: (805) -56-0400
LICENSING EVALUATOR NAME: Aaliyah ZendejasTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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