Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290751
Report Date: 03/15/2017
Date Signed: 03/15/2017 04:12:13 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
12/20/2016 and conducted by Evaluator Myriam Luga
COMPLAINT CONTROL NUMBER: 30-CC-20161220114941
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
UNANNOUNCEDTIME BEGAN:
01:24 PM
MET WITH:Sylvia PoltkinsTIME COMPLETED:
03:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Myriam Saullo Luga conducted a visit to further investigate the allegation of a child severly pulling another child's hair. LPA met with the facility director and explained the purpose of the visit. LPA toured the faciltiy indoor and outdoor. There were 25 children and six staff present during the visit. LPA observed children's interaction with each other and it was positive. LPA observed teachers providing visual supervision to all children and interacting well with them during the visit. LPA interviewed staff and children. LPA reviewed attendance records and children's records.
LPA notified the facility director that based on faclility inspection/evaluation, review of children's records and staff's records, statements provided, above allegation is deemed unsubstantiated meaning 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 along with the appeal rights were provided 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: 03/15/2017
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.
LIC9099 (FAS) - (06/04)
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