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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600650
Report Date: 01/17/2023
Date Signed: 01/17/2023 05:56:17 PM

Document Has Been Signed on 01/17/2023 05:56 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:STEPHEN S. WISE TEMPLE PRE-SCHOOLFACILITY NUMBER:
191600650
ADMINISTRATOR:JAYNE ROSENFACILITY TYPE:
850
ADDRESS:15500 STEPHEN S. WISE DR.TELEPHONE:
(310) 889-2248
CITY:LOS ANGELESSTATE: CAZIP CODE:
90077
CAPACITY: 298TOTAL ENROLLED CHILDREN: 173CENSUS: 51DATE:
01/17/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jayne Rosen, Interim Director TIME COMPLETED:
06:00 PM
NARRATIVE
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On 01/17/2023 at 1:00 pm Licensing Program Analyst (LPA), Deborah Lowe conducted an announced case management visit at facility for the purpose of evaluating two rooms the facility reported had flooding. LPA Lowe met with facility representative Jayne Rosen. LPA Lowe observed 51 children under supervision of 22 staff.

Rooms 52 and 54 were reported with flooding due to the recent rain fall. Facility is requesting to temporarily use Multi purpose room A and B located in the Temple building until room 52 and 54 are cleared to use.

LPA Lowe measured multi purpose room A and B:

Multi purpose room A: 620.65 square feet divided by 35 square feet = 17 children. Facility is requesting a maximum of 10 children.

Multi purpose room B: 636.77 square feet divided by 35 square feet = 18 children. Facility is requesting a maximum of 14 children.

Children in the multi purpose A and B will have access to 2 toilets and 4 sinks. Furniture and equipment were observed to be age appropriate and in good condition.

From 1:15 pm to 2:04 pm LPA Lowe was lead by facility representative Jayne Rosen on classroom tours, LPA Lowe observed 51 children under supervision of 22 staff. LPA Lowe interviewed staff and interim director and found 6 staff have background clearance but are not associated to the facility and 8 staff do not have record of a CCLD background clearance completed.

This observation will result in two Type A Citations with a Civil Penalty of $6,900.00.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: STEPHEN S. WISE TEMPLE PRE-SCHOOL
FACILITY NUMBER: 191600650
VISIT DATE: 01/17/2023
NARRATIVE
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LPA Lowe advised for the staff with no CCLD background clearance per CC Regulation 101170(e)(1) Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.

LPA Lowe advised for the staff in need of a criminal record transfer, per CC Regulation 101170(e)(2) Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f).

LPA Lowe reviewed the uses and benefits of Guardian for managing background clearance. Per facility representative they have watched Guardian tutorials but have not signed up yet.

During visit LPA observed the Witzman building currently under construction. Facility Representative Jayne Rosen stated Rooms 10, 11. 12, 13, 14, and 15 were located in the Witzman building. LPA observed the building to have been torn down and the area currently observed flat with dirt/ mud with large construction equipment. Per Jayne, the facility broke ground on the construction in October 2022.

LPA Deborah Lowe informed facility representative Jayne Rosen that this report dated 01/17/2023 document(s) two Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Deborah Lowe informed the facility representative to provide a copy of this licensing report dated 01/17/2023 that documents any Type A citation(s) 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 (LIC 9224), or other written statement, must be placed in the child's file for verification.

Facility representative 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.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023
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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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: STEPHEN S. WISE TEMPLE PRE-SCHOOL
FACILITY NUMBER: 191600650
VISIT DATE: 01/17/2023
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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.

Appeal rights were provided.

Exit interview conducted and report was reviewed with the facility representative, Jayne Rosen.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Deborah Lowe
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023
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Document Has Been Signed on 01/17/2023 05:56 PM - It Cannot Be Edited


Created By: Deborah Lowe On 01/17/2023 at 05:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: STEPHEN S. WISE TEMPLE PRE-SCHOOL
FACILITY NUMBER: 191600650

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/17/2023
Section Cited
CCR
101170(e)(1)

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101170(e)(1) Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working,... in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.
This requirement is not met as evidenced by:
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On 01/17/2023 Staff were sent home. Per Interim Director staff will be sent for live scan on 1/18/2023, facility will email LPA Lowe at deborah.lowe@dss.ca.gov on or before 1/20/2023 with Live scan receipts. Interim director was advised staff shall not return until criminal background clearance has completed and a letter from Guardian has been received.
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Based on observations, interviews, and review of Guardian the facility did not ensure background clearance was obtained for 8 adults who were in care and supervison of children which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
01/17/2023
Section Cited
CCR101170(e)(2)

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101170(e)(2) Criminal Record Clearance: (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f).
This requirement is not met as evidenced by:
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On 01/17/2023 Staff were sent home. Per Interim Director LIC9182 will be completed and emailed on 1/18/2023, facility will email documents to esrosupportstaff@dss.ca.gov. Interim director was advised staff shall not return until criminal background clearance has completed and a letter from Guardian has been received.
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Based on observations, interviews, and review of Guardian the facility did not ensure criminal background transfers were obtained for 6 adults who were in care and supervison of children which poses an immediate health, safety or personal rights risk to persons 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:Lisa Rios
LICENSING EVALUATOR NAME:Deborah Lowe
LICENSING EVALUATOR SIGNATURE:
DATE: 01/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/17/2023


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