300600077-2-12-2025-06-CC-AFCN-DDTRLS-20250212120737

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300600077
Report Date: 02/12/2025
Date Signed: 02/12/2025 12:07:49 PM

Document Has Been Signed on 02/12/2025 12:07 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	TEMPLE BETH TIKVAH EARLY CHILDHOOD LEARNING CENTE		FACILITY NUMBER:	300600077
ADMINISTRATOR/ DIRECTOR:	WIRTZER, NATALIE		FACILITY TYPE:	850
ADDRESS:	1600 N ACACIA AVENUE		TELEPHONE:	(714) 871-9555
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92831
CAPACITY: 48	TOTAL ENROLLED CHILDREN: 48	CENSUS: 6	DATE:	02/12/2025
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:50 AM
MET WITH:	Director Rachel White		TIME VISIT/ INSPECTION COMPLETED:	12:25 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 02/12/25 at 8:50am, Licensing Program Analyst (LPA), Anna Chan conducted an unannounced onsite inspection for the purpose of an Annual Random Visit. LPA met with Director Rachel White and toured the facility inside and outside and the floor and yard plan were verified. Census was taken. The overall census observed was 6 children and 2 staff. Children were having AM snack when LPA arrived. During the inspection it was determined the facility is operating within its licensed capacity and within compliance of staffing ratios. Facility hours are 7:30a.m.- 6:00p.m., Monday through Friday. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. During the inspection of the indoor activity space, items which could pose a danger to children (detergents, cleaning compounds, and medications) were observed to be stored out of the reach of children. Poisons/Hazardous Items are not kept on the premises. The parents provides AM snacks for all children and lunches are brought from home. Children bring sports bottles properly labeled with their names, water refill is provided by the facility through water fountain. Children nap on cots and beddings are stored individually. Sheets and blankets are brought home weekly for washing. The facility has a working carbon monoxide detector and fire extinguisher. The facility conducted an emergency drill on November 11, 2024. Facility met all posting requirement. The California Child Passenger Safety Law was posted by the entrance of the facility. Page 1 of 3

SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 4

Document Has Been Signed on 02/12/2025 12:07 PM - It Cannot Be Edited

Created By: Anna Francesca Chan On 02/12/2025 at 11:38 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TEMPLE BETH TIKVAH EARLY CHILDHOOD LEARNING CENTE	FACILITY NUMBER: 300600077
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/12/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 3 stafff did not have health screening readily available in their file.1 staff has it at home and 1 staff did not have the physician fill up the correct health screening form. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/28/2025
	Plan of Correction
1 2 3 4	Director stated she will provide LPA a copy of health screening with TB test for 2 staff by due date 2/28/25.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Martha Malane

LICENSING EVALUATOR NAME:

Anna Francesca Chan

LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC809 (FAS) - (06/04)

Page: 2 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TEMPLE BETH TIKVAH EARLY CHILDHOOD LEARNING CENTE	FACILITY NUMBER: 300600077
	VISIT DATE: 02/12/2025

NARRATIVE

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The outdoor activity space was inspected for compliance. The preschool playground was enclosed by a fence at least four feet in height. The surface of the outdoor activity space was well maintained and free of hazards. The playground was cushioned by pour in place rubberized surface which appears to be enough to absorb falls. There is a paved area and sand box area in the playground. Drinking water in the outdoor activity space is provided by water fountain and refillable sports bottles with the children’s name on it. The outdoor equipment and toys were in good repair and free of sharp edges. There are no bodies of water present at the facility, and none was observed during today’s visit.

3 Staff files were reviewed for staff present during the facility inspection on this date. Health screening and immunization as required were reviewed. Beginning September 1, 2016, Health and Safety (H&S) 1596.7995 (a)(1) a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.
Proof of immunization against pertussis, measles for the facility were reviewed. Based on records reviewed, 2 of 3 staff were missing LIC503 Health Screening with TB test and LPA was not able to review.

Beginning March 31, 2018, H&S Code 1596.8662 requires all directors and employees to complete mandated reporter training, and to renew the training every two years. At least one staff member present possesses current EMSA approved Pediatric CPR/First Aid certifications, which expires 07/12/2026.

5 Children's records were reviewed, and there was a separate, complete, and current record for each child. Sign in and out through Playground app was reviewed. Each child representative has their own log in ID. In the areas reviewed the children’s files were found to be in full compliance.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: TEMPLE BETH TIKVAH EARLY CHILDHOOD LEARNING CENTE	FACILITY NUMBER: 300600077
	VISIT DATE: 02/12/2025

NARRATIVE

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Currently, there are no medications in the facility. 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

Transfer Request (LIC9182). The Director was informed that Licensing Quarterly Updates are available at www.ccld.ca.gov Site Supervisor may request to be added to an email list to receive a Quarterly Update by contacting the Child Care Advocate at childcareadvocatesprogram@dss.ca.gov or at www.ccld.ca.gov
LPA provided Guardian Information and website info: https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian

Based on records reviewed and interview the following Type B violation was observed and is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101216(g)(1) Personnel Requirements. See attached LIC809D.

An Inspection and exit interview were completed with Director Rachel White. The report was reviewed and discussed. Appeal Rights and deficiency were discussed. The director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

The director was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.

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SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Anna Francesca Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC809 (FAS) - (06/04)

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