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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 566215054
Report Date: 09/10/2024
Date Signed: 09/13/2024 12:16:01 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/17/2024 and conducted by Evaluator Aaliyah Zendejas
PUBLIC
COMPLAINT CONTROL NUMBER: 17-CC-20240617084151
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
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Debbie BlumenthalTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff did not to provide appropriate supervision to child in care.
CCC did not report Incident to child's authorized representative/CCLD
INVESTIGATION FINDINGS:
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On September 10 , 2024 Licensing Program Analyst (LPA) Aaliyah Zendejas conducted an unannounced visit to deliver the findings of the above mentioned allegations. LPA met with Director Debbie Blumenthal and advised her of the purpose of the inspection. Together with the Director, LPA toured the interior and exterior of the facility. At the time of the inspection, there were 20 children under the care and supervision of 12 staff members.
CCLD received a complaint with two allegations stating, CCC did not report Incident to child's authorized representative/CCLD, and that facility did not provide appropriate supervision to child in care. Upon conducting file review and doing staff and parent interviews, there were incidents that were mentioned during staff and parent interviews that were not within file or called in to licensing. LPA Zendejas while conducting staff and parent interviews heard about instances that were not reported to licensing or the child’s authorized representative but were acknowledged by staff and / or Director. LPA Zendejas reminded Director about reporting requirements and told Director to review reporting requirements with staff and to keep a log of incident reports within the facility. CON'D ON 9099-C
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 17-CC-20240617084151
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
VISIT DATE: 09/10/2024
NARRATIVE
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LPA Zendejas upon conducting staff and parent interviews, instances of children being left unattended were mentioned stating that these instances have occurred and have not gone unreported. While investigating, there had been admittance of knowing that children had been left unattended or had been directly involved in incidents were children were left unattended. LPA Zendejas advised Director to review Title 22 requirements regarding supervision of children within CCC.

Based on LPAs observations, documents gathered and/or record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 or Health and Safety Code, are being cited on the attached LIC 9099D.

Also, LPA Zendejas informed the licensee to provide a copy of this licensing report dated 09/10/2024 that documents any type A citations to parents / guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents / guardians for 12 months from the date of this report. A signed Acknowledgement of receipt of licensing report (LIC9224) or other written statement must be placed in the child's file for verification.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted, appeal rights were given, and report was reviewed with 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
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 17-CC-20240617084151
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 A
09/10/2024
Section Cited
CCR
101229(a)(1)
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101229Responsibility for Providing Care and Supervision(a)The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time ... Supervision shall include visual observation. This requirement is not met as evidenced by:
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Director is to review with staff, the regulations regarding children being left unsupervised and create a plan as to how they are going to combat this from occurring again within the facility.
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Based on observation and interviews conducted, Center did not comply with the deficiency cited above as a child was found wandering outside with no supervision which poses an immediate risk to the health, safety and or personal rights of children in care.
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Type B
09/24/2024
Section Cited
CCR
101212(d)(1)(C)
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101212 Reporting Requirements (d) A report shall be made to the Department by telephone...In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department... (1) Events reported shall include the following:(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement is not met as evidenced by:
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Director is to review reporting requirements with staff and create a plan as to how they are going to report necessary instances to both the department and authorized representatives on time.
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Based on record review and interviews conducted, center did not comply with the deficiency cited above as which there have been incidents that have gone unreported to parents and / or CCLD which poses a potential 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
LIC9099 (FAS) - (06/04)
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