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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372001648
Report Date: 12/16/2021
Date Signed: 12/16/2021 02:41:36 PM

Document Has Been Signed on 12/16/2021 02:41 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, 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: 74CENSUS: 53DATE:
12/16/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jennifer LowTIME COMPLETED:
10:00 AM
NARRATIVE
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On 12/16/21 @ 9:15AM, Licensing Program Analysts (LPAs) Nancy Diaz and Tyra Block conducted an unannounced case management inspection. Met and toured the classrooms with acting director Jennifer Low. Also present during this inspection was Jamie Nadel, Executive Director of Synagogue. Observed present today were 53 preschool children in the following classrooms:
Rm #3 (2's) with 9 children and staff Andra Espinosa
Rm #2 (2's) with 10 children and staff Madison Sigurdson, Emily Castillo & Brittany Fabing
Rm #14 (pre-k) with 6 children and staff Diana Korkis & Erin Vanderhyde
Rm #12 (pre-k) with 7 childrena nd staff Miah Missick
Rm #11 (3's) with 4 children and staff Tamara Mitchell & Baharak Rezaie
Rm #10 (3's) with 5 children and staff Jessica Wheeler & Melody Schultz
Rm #8 (2's & 3's) with 12 children and staff Savannah Drover, Melina Huerta, Katelyn Elleraas & Wisam Alimari.

LPA Nancy Diaz reviewed all staff files.

Type A and B deficiencies were cited today. Civil penalties were also assessed.
Type A deficiency if not corrected will have a direct and immediate risk to the health, safety or personal rights of children in care.
Type B deficiency if not corrected poses a potential risk to the health, safety or personal rights of children in care.

An exit interview was conducted with Jennifer Low. Appeal rights were discussed a copy provided. Notice of site visit was observed posted. This notice shall remain posted for 30 days.

Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Nancy Diaz
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.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/16/2021 02:41 PM - It Cannot Be Edited


Created By: Nancy Diaz On 12/16/2021 at 12:52 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
, 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 A
12/16/2021
Section Cited
CCR
101170(e)(1)

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CRIMINAL RECORD CLEARANCE. 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.
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CORRECTED:
Staff Jessica Wheeler was associated to the facility on 10/21/21. Jennifer Low fax'd her LIC 9182 today, 12/16/21.
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This requirement was not met as evidenced by: Based on file review and observation by staff Tyra Block on 10/20/21, staff Jessica Wheeler was present in Room #2. Jessica Wheeler did not have a fingerprint clearance associated to the facility. Site Director Jennifer Low was present today. Her fingerprint clearance is not associated to the facility. Ms. Low was hired in August 2021.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
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


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Document Has Been Signed on 12/16/2021 02:41 PM - It Cannot Be Edited


Created By: Nancy Diaz On 12/16/2021 at 01:12 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
, 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
12/23/2021
Section Cited
HSC
1596.8662(b)(1)

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MANDATED REPORTER.
) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training ... and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
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Mrs. Low stated that she will notify staff and have them complete the course no later than 12/23/21. Copy of certificates are due no later than 12/23/21.
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This requirement is not met as evidenced by: Based on file review, the following staff need to obtain a current Mandated Reporter Training Certificate: Jennifer Low; Brittany Fabing; Katelyn Elleraas; Jessica Wheeler; Erin Vanderhyde; Maria Guerrero; Madison Sigurdson; Even Sabri; Emily Castillo; Andrea Espinosa; Abigail Hernandez; Larisa Boruknov & Rosie Torreblanca.
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Type B
12/23/2021
Section Cited
HSC1597.622(a)(1)

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STAFF IMMUNIZATION.
Commencing September 1, 2016, a person shall not be employed or volunteer... if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
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Mrs. Low stated that she will notify staff and have them submit copies of their immunization record. Proof of correction is due to the department no later than 12/23/21.
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This requirement was not met as evidenced by: Based on file review the following staff did not have proof of being immunized against pertussis, measles or influenza: Diana Korkis; Maria Guerrero; Madison Sigurdson; Emily Castillo; Andrea Espinosa & Abigail Hernandez.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
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


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/16/2021 02:41 PM - It Cannot Be Edited


Created By: Nancy Diaz On 12/16/2021 at 01:26 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
, 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
12/23/2021
Section Cited
CCR
101216.1

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TEACHER QUALIFICATION.
A photocopy of the teacher's Child Development Permit as specified in (c)(3) above, or a photocopy of the teacher's transcript(s) documenting successful completion of required course work, shall be maintained at the center.
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Mrs. Low stated that she will obtain copies of staff transcript and will submit to the department no later than 12/23/21.
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This requirement was not met as evidenced by: Based on file review, the following staff are missing a copy of their transcript to verify teacher qualification: Savannah Drover; Andrea Espinosa & Abigail Hernandez.
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Type B
12/23/2021
Section Cited
CCR101216

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PERSONNEL REQUIREMENTS.
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.
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Mrs. Low stated that she will obtained the required Health Screening and submit to the department no later than 12/23/21.
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This requirement was not met as evidenced by: Based on file review, the following staff are missing the Health Screening form: Jennifer Low; Katelyn Elleraas; Diana Korkis; Madison Sigurdson; Emily Castillo & Andrea Espinosa.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
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


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/16/2021 02:41 PM - It Cannot Be Edited


Created By: Nancy Diaz On 12/16/2021 at 01:47 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
, 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
12/23/2021
Section Cited
CCR
101212(b)

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REPORTING REQUIREMENTS.
The name of the child care center director, and any fully qualified teacher(s) designated to act in the child care center director's absence, shall be reported to the Department within 10 days of a change of child care center director or designee(s).
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Mrs. Low stated that she will submit the designation form LIC 308 with attached required documents to the department no later than 12/23/21 - copy of transcript; mandated reporter cert; photo ID; health screening; LIC 500; LIC 610; CPR/First Aid certificate.
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This requirement was not met as evidenced by: Based on file review licensee failed to submit the designation for acting director Jennifer Low.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Nancy Diaz
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


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