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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671596
Report Date: 12/03/2024
Date Signed: 12/03/2024 01:29:46 PM

Document Has Been Signed on 12/03/2024 01:29 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BETH SHOLOM TEMPLE NURSERY SCHOOLFACILITY NUMBER:
191671596
ADMINISTRATOR/
DIRECTOR:		RANDEE NORWOODFACILITY TYPE:
850
ADDRESS:1827 CALIFORNIA AVENUETELEPHONE:
(310) 829-2517
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 39DATE:
12/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Robin MasnicoffTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 12/03/2024, Licensing Program Analysts (LPA) Judy Laureano and Brittany Lovest conducted a case management inspection to follow up on an Unusual Incident reported to the department on 11/21/2024. LPA Laureano and Lovest were greeted by Robin Masnicoff facility director who guided LPAs on facility tour.

LPAs observed all the licensed classrooms and the outdoor area. The following was observed:
Toddler Classroom- 7 children and 2 staff members
Classroom 3- 6 children and 1 staff member
Classroom 4- 12 children and 2 staff members
Classroom 5- 13 children and 2 staff members

The El Segundo Child Care Regional Office (ESRO) received information from executive director via telephone regarding a self-reporting incident that occurred at the facility on 11/20/2024. Based on the Unusual incident report submitted, on 11/20/24 at approximately 9:15am, Child #1 who is 23 months was playing on outdoor play structure. As she was walking down the stairs, she lost her footing and fell. Two teachers present, staff 1 and staff 2. Staff 1 observed child wobbling and tried to get her. In the meantime, the child fell down a couple of stairs. Staff 1 did not observe any bruises or scrapes. The child was crying so the parents were contacted and asked to pick up the child. The child was taken to doctor and X-rays showed child's right shoulder has a fracture of the growth plate. Parent submitted a doctor's note that allows child to return on 11/22/24 with restrictive play. During the time of the incident, there were 7 children with two teachers present in the outdoor space.

Director confirmed child is able to be back in care with doctor's restriction- child cannot be on the play structure while on a soft brace.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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 12/03/2024 01:29 PM - It Cannot Be Edited


Created By: Judy Laureano On 12/03/2024 at 11:48 AM
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: BETH SHOLOM TEMPLE NURSERY SCHOOL
FACILITY NUMBER: 191671596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
12/27/2024
Section Cited
CCR
101216.4(2)

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(2) The toddler program shall be conducted in areas physically separate from those used by older or younger children...Plans to alternate use of outdoor play space must be approved by the Department.
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Director agrees to ensure children in the toddler component use the designated outdoor space. Director agrees to add visible barriers to ensure both staff and children use the appropriate designated area.
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Based on the LPA's observation, information obtained and interviews conducted, child enrolled in the toddler program sustained injury while using the outdoor space NOT designated for the toddler program.
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Director will submit updated facility sketch of both indoor and outdoor space to LPA by 12/27/2024

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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Judy Laureano
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2024


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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: BETH SHOLOM TEMPLE NURSERY SCHOOL
FACILITY NUMBER: 191671596
VISIT DATE: 12/03/2024
NARRATIVE
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LPAs interviewed staff named in the incident report and interviewed child.

Based on the LPA's observation, information obtained and interviews conducted, child enrolled in the toddler program sustained injury while using the outdoor space NOT designated for the toddler program. Facility was issued a Type A citation.

LPA Laureano and Lovest informed director Robin Masnicoff that this report dated 12/3/2024 that documents 1 Type A citation which shall be posted for 30
consecutive days as there is immediate risk to the health, safety, or
personal rights of children in care.

Also, LPA Laureano and Lovest informed the director, Robin Masnicoff, to provide a copy of this licensing report dated 12/3/2024 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


An exit interview was conducted with director Robin Masnicoff. A copy of this report with appeal rights and Notice of Site Visit was provided and reviewed with Robin Masnicoff.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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