Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290751
Report Date: 03/21/2016
Date Signed: 03/21/2016 12:40:55 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2016 and conducted by Evaluator Myriam Luga
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20160211095302
FACILITY NAME:TEMPLE B'NAI HAYIM NURSERY SCHOOLFACILITY NUMBER:
191290751
ADMINISTRATOR:SASHA BARAHONAFACILITY TYPE:
850
ADDRESS:4276 VAN NUYSTELEPHONE:
(818) 788-4664
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:42CENSUS: 20DATE:
03/21/2016
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Sylvia PoltkinsTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Lack of supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Myriam Saullo Luga conducted a visit to further investigate above allegation. LPA met with the facility director and explained the puprose of the visit. LPA , with the facility director, toured the faciilty indoor and outdoor. There were 20 children and 5 staff including the facility director present during this visit. The facility looked orderly. Children were engaged in outdoor play during the visit. Teachers were providing visual supervision to children at all times during the visit.
LPA interviewed parents during the visit. LPA further reviewed the facility's policies/procedures.
LPAs notified the facility director that based on facility inspection, records review, statements provided by parents, children and staff, review of the facility's policies and procedure, facility observation on 2/18/2016 and 3/21/2016, above allegation is deemed to be inconclusive, which means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation occurred.
An Exit interview was conducted and a copy of this report was submitted to the facility.
Inconclusive
Estimated Days of Completion:
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-4332
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2016
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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