Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290751
Report Date: 06/20/2018
Date Signed: 06/20/2018 10:10:09 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:TEMPLE B'NAI HAYIM NURSERY SCHOOLFACILITY NUMBER:
191290751
ADMINISTRATOR:LILY GARCIAFACILITY TYPE:
850
ADDRESS:4276 VAN NUYSTELEPHONE:
(818) 788-4664
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:42CENSUS: DATE:
06/20/2018
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:10 AM
MET WITH:Lily GarciaTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), Marina Pilossian conducted a case management inspection and met with the Director Lily Garcia. LPA observed 12 children playing on the playground upon arrival with 2 teachers.

The purpose of this inspection is in regards to an incident that occurred on 03/21/2018, whereby a preschool child sustained a seizure in the classroom.

LPA reviewed child's record. LPA interviewed director, staff and child's parent. The child was attended to by staff immediately and the paramedics were called. The child was transported to the hospital and released. The child returned to the school the following week.

The child remained at home for a few days. When child returned to the facility parents provided director with a medical note that child may return to school 03/26/2018. Parents will be notified immediately if child shows any physical signs out of the unusual. The Center has met the reporting requirements. No further action is required.

Based on the information reviewed and obtained there are no violations.

Exit interview & report provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2018
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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