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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372001648
Report Date: 01/19/2022
Date Signed: 01/19/2022 11:23:58 AM

Document Has Been Signed on 01/19/2022 11:23 AM - 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
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: 89TOTAL ENROLLED CHILDREN: 0CENSUS: 62DATE:
01/19/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Jen LoweTIME COMPLETED:
11:12 AM
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LPA, Tyra Block, conducted a Plan of Correction Visit on 1/19/22 to inspect the playground for correction of deficiency cited 12/16/21-101238.2(d)(2) Outdoor Activity Space. LPA met with Interim Director, Jen Lowe. Area of playground rubber matting with dip has been corrected by placing table/bench over the top.

During this visit the written report was completed and signed. Notice of Site Visit was provided. It must be posted for 30 days.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Tyra Block
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2022
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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