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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372001648
Report Date: 12/16/2021
Date Signed: 12/16/2021 04:30:19 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/11/2021 and conducted by Evaluator Tyra Block
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20211011112456
FACILITY NAME:SILVERMAN PRESCHOOL OF TIFERETH ISRAEL SYNAGOGUEFACILITY NUMBER:
372001648
ADMINISTRATOR:AMY STANLEYFACILITY TYPE:
850
ADDRESS:6660 COWLES MOUNTAIN BOULEVARDTELEPHONE:
(619) 697-1948
CITY:SAN DIEGOSTATE: CAZIP CODE:
92119
CAPACITY:89CENSUS: 57DATE:
12/16/2021
UNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Jamie Nadel and Jen LoweTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Playground is in disrepair
INVESTIGATION FINDINGS:
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On 12/16/21 Licensing Program Analyst (LPAs), Tyra Block and Nancy Diaz made an unannounced complaint visit for the complaint received on 10/11/21 for the purpose of delivering findings on the above referenced allegation. Present today were 53 children with 17 teaching staff.

LPAs also observed sinking in the rubber matting on the payground which poses a safety risk. Based on the information obtained during interviews and observation it is determined that the allegation is valid because the preponderance of the evidence has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 12, Chapter number) the deficiency is being cited on the attached LIC 9099D. The Notice of Site Visit was provided, and LPA observed posting. Licensee is advised it must remain posted for 30 days. An exit interview was conducted, A copy of this report and Appeal Rights (1/16) were discussed and provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
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 2
Control Number 51-CC-20211011112456
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: SILVERMAN PRESCHOOL OF TIFERETH ISRAEL SYNAGOGUE
FACILITY NUMBER: 372001648
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2021
Section Cited
CCR
101238.2(d)(2)
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101238.2(d)(2) Outdoor Activity Space:The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard. This requirement was not met as evidenced by:
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The director stated the rubber matting will be repaired so that it is leveled and even to reduce the risk of injury. It must be corrected by 12/31/21.
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Based on observation the rubber matting on the playground to the right has a dip/ sinking spot that poses a potential health and safety risk to 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.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2