Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290751
Report Date: 03/15/2017
Date Signed: 03/15/2017 01:50:36 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:TEMPLE B'NAI HAYIM NURSERY SCHOOLFACILITY NUMBER:
191290751
ADMINISTRATOR:SYLVIA POLTKINSFACILITY TYPE:
850
ADDRESS:4276 VAN NUYSTELEPHONE:
(818) 788-4664
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:42CENSUS: 25DATE:
03/15/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Sylvia PoltkinsTIME COMPLETED:
01:22 PM
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Licensing Program Analysts (LPA ) Myriam Saullo Luga met with facility director, for the purpose of conducting an annual random visit. They toured/inspected the facility. The facility utilizes 3 classrooms. There were 25 children and 6 staff during the visit . Furniture and equipment were inspected for age appropriateness and good repair. The facility was observed to operate within the license capacity. Telephone service, heating, lighting and ventilation were evaluated and were in compliance with Title 22 regulations. Storage for children's belongings was noted to be proper and individualized. Isolation area is in the director’s office which is by a restroom and it was inspected and was orderly. LPA inspected the bathroom utilized by children and it was equipped with 3 Age appropriate sinks and 3 toilets which were inspected for availability, good repair, water temperature, toilet paper, paper towels, soap, area safety and sanitation and all were in order. First Aid supplies were inventoried and smoke detectors/fire extinguishers/carbon monoxide detector were observed to be well serviced. A review of medication policy, including administering, labeling, storage, and records was completed. Sign in and out sheets were reviewed and were complete. Napping equipment was inspected and was in good repair. Documentation of Fire and Earthquake drills , Emergency disaster plan were posted. Activity Schedule was posted in all classrooms. Snack/lunch menus were observed to be visible for parents to review as needed. Trash cans in the classrooms had lids on. Snacks were stored in the kitchen area which was clean and the facility only provides snacks for children. Food preparation area was inspected and it met Title 22 regulations. Cleaning supplies were stored out of children’s reach. During the visit, all Classrooms had drinking water via water pitcher and cups available for children as needed. Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water ( water fountain) and fencing were inspected and they were in compliance with Title 22 regulations. Climbing structures/slides and other large play equipment were found to be securely anchored with adequate resilient cushioning material underneath and around the perimeter.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-4332
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2017
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: TEMPLE B'NAI HAYIM NURSERY SCHOOL
FACILITY NUMBER: 191290751
VISIT DATE: 03/15/2017
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Facility director was reminded to keep the playground maintained at all times.
LPA reviewed children’s files during this inspection and all were complete.
Teachers' personnel records were reviewed and were complete. All teachers and the facility director have current certificates of pediatric first aid and CPR which expire in 11/2017.
LPA discussed with facility director in depth incidental medical services . Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.htmThe facility director indicated the facility does not provide incidental medical services.
LPA addressed with the facility director Senate Bill 277- eliminating exemption for immunizations for children attending public school and child care based facilities upon personal beliefs, leaving the medical exemption in place, and Senate Bill 792 that indicated that a person from being employed or volunteering at a child care facility needs immunization against influenza, pertussis and measles. LPA reviewed staff's files and records of immunization against influenza, pertussis and measles were noted.
LPA provided the facility director with the Department’s website: www.ccld.ca.gov.
The director was reminded that the Notice of Site Visit, provided at this visit, must be posted to be visible for a period of 30 days.
No deficiency was noted and no citation was issued during this visit.
Exit interview was conducted and a copy of this report was submitted to facility director.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (310) 337-4332
LICENSING EVALUATOR NAME: Myriam LugaTELEPHONE: (310) 337-4365
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2