566215054-4-10-2023-17-CC-ARIS-CQRR95-20230410124858

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 566215054
Report Date: 04/10/2023
Date Signed: 04/10/2023 12:49:07 PM

Document Has Been Signed on 04/10/2023 12:49 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:	566215054
ADMINISTRATOR:	DEBBIE BLUMENTHAL		FACILITY TYPE:	830
ADDRESS:	1080 E. JANSS ROAD		TELEPHONE:	(805) 497-6852
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	50	CENSUS: 33	DATE:	04/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Debbie Blunmenthal		TIME COMPLETED:	01:02 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 April 10, 2023 at 9:50 am, Licensing Program Analyst (LPA) Austin Rios conducted a Required Annual inspection. LPA met with Director Debbie Blunmenthal and advised her the purpose of the inspection. LPA conducted a tour of the facility inside and out. There were 33 children in care at the time of the inspection with fourteen staff. The center operates from 7:30 AM to 6:00 PM, Monday thru Friday. This is a combination center with a pre-school program. Center uses electronic sign in sheet called bright wheel and uses four classrooms for the infant program. The classrooms were found to be orderly and free of toxins. There is a functioning carbon monoxide detector that meets statutory requirement. All required State forms were posted. The outdoor play area is completely fenced and LPA observed age appropriate toys, and equipment. Drinking water is available inside and outside. Teacher files reviewed and were found complete with State required forms. Teacher's Medical Health Records verified. Teachers are current with CPR and First Aid which expires 7/2024. Children's files reviewed and found complete. Center staff completed Mandated Reporter Training and were on file. There was a diaper changing table within an arm's reach to the sink. Each child had their infant needs and services plan as well as their own individual feeding plan. The refrigerator had each child's formula, sipping cups, bottles lined up in their own tray and the older infants use mats for nap time and sheets are washed every night as well as mats are sanitized daily. Facility has sufficient amount of cribs and LPA observed no objects hanging above. Facility is conducting fifteen minute check when infants are sleeping and LPA verified proof. LIC 9227 infant safe sleep forms were filled out. Cont on 809C.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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: 566215054
	VISIT DATE: 04/10/2023

NARRATIVE

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Licensee 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 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 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

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.htm

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.

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

Exit interview conducted and report was reviewed with the licensee Debbie Blunmenthal.

SUPERVISOR'S NAME: Ana Tolentino	TELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Austin Rios	TELEPHONE: (805) 635-4725
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC809 (FAS) - (06/04)

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