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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215054
Report Date: 09/10/2024
Date Signed: 09/10/2024 12:04:07 PM


Document Has Been Signed on 09/10/2024 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:
566215054
ADMINISTRATOR:DEBBIE BLUMENTHALFACILITY TYPE:
830
ADDRESS:1080 E. JANSS ROADTELEPHONE:
(805) 497-6852
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:50CENSUS: 20DATE:
09/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Debbie Blumenthal TIME COMPLETED:
12:25 PM
NARRATIVE
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On September 10, 2024 at 10:46 AM, Licensing Program Analyst (LPA) Aaliyah Zendejas made an unannounced visit for the purpose of conducting a Case Management - Incident inspection. LPA met with Debbie Blumenthal to discuss an incident that was self reported to Community Care Licensing Division (CCLD) office via email / voicemail on 06/14/2024. LPA toured the interior and exterior of the facility with the Director and interviewed staff related to the incident that was sent in.

On 06/13/2024 an incident occurred at the center that was reported and called in the next day. S1 came to the assistant director and notified them about an incident that had occurred the previous day involving a staff member who had placed a child in the closet and left them there for a couple seconds as a form of punishment. After hearing about the incident, the director interviewed staff related to the incident and then terminated the staff member who had placed the child in the closet. Assistant director notified parents of the incident that occurred.

The child returned the next day but did not return the next school year. To prevent any similar incidents, the licensee has terminated the staff member and met with other staff regarding personal rights.

Given the incident did occur in the facility, one Type B deficiency is being cited today. See 809-D for details.

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: 09/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024
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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Document Has Been Signed on 09/10/2024 12:04 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117


FACILITY NAME: TEMPLE ETZ CHAIM PRESCHOOL
FACILITY NUMBER: 566215054

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/24/2024
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature... This requirement is not met as evidenced by:
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Director is to review personal rights requirements with staff and develop a plan for staff members in center to ease stress or frustration while taking care of children. Director is to submit written plan to department.
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Based on record review and interviews conducted, Center did not comply with the deficiency cited above as a child was placed in a closet when a staff member got upset at the child which poses an immediate risk to the health, safety and or personal rights of children in care.
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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: Lissete GonzalezTELEPHONE: (805) -56-0400
LICENSING EVALUATOR NAME: Aaliyah ZendejasTELEPHONE: (805) 722-5133
LICENSING EVALUATOR SIGNATURE:
DATE: 09/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2024
LIC809 (FAS) - (06/04)
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