Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415614
Report Date: 09/07/2018
Date Signed: 09/07/2018 04:01:20 PM

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:GAN SHELANU PRESCHOOL CENTERFACILITY NUMBER:
197415614
ADMINISTRATOR:MEIR, ILANITFACILITY TYPE:
850
ADDRESS:13625 BURBANK BLVD.TELEPHONE:
(818) 266-4953
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91401
CAPACITY:40CENSUS: 25DATE:
09/07/2018
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Ilanit MeirTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Marina Pilossian conducted a Plan of Correction inspection (POC). During a site inspection on 08/30/2018, the following deficiencies were cited:
1) Reporting Requirements.(licensee failed to report to the Department of Social Services/Community Care Licensing Office of an incident that occurred on 07/09/2018).
2) Personal Rights: Staff used inappropriate form of discipline by screaming, raising her voice at the children (toddlers) on 07/09/2018.

A census of the children was taken during today's inspection. LPA observed 17 children with 2 staff in the Pre K classroom, and 8 children in the pre school room with 1 teacher. Total census 25 pre school age children. .LPA and licensee/director toured the facility inside and outside at 12:45pm on 09/07/2018. LPA observed the Notice of Site visit posted in each classroom and the Acknowledge of Receipt Of Licensing Reports (LIC9224) signed by parents/guardians and placed in each child's file.

The following correction have been made to the facility:
1) Personal Rights: Licensee conducted training on Personal Rights with staff.
2) Reporting Requirements (licensee faxed a copy of the incident report that occurred on 07/09/2018 to the Department).

LPA reviewed all 25 children's files that were present at the center during the inspection. LPA observed child #1, #2, and #3 missing immunization. Licensee was not able to provide copies of immunization to the LPA during the inspection for review.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GAN SHELANU PRESCHOOL CENTER
FACILITY NUMBER: 197415614
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2018
Section Cited
CCR
101220.1(g)
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Immunizations.

The child’s immunizations shall be documented and maintained on file as long as the child is enrolled. Child #1, #2, and #3 did not have immunization record on file. The requirement is not met as evidenced by
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Per Director, will obtain a copy of the record and submit to LPA by POC due date 09/21/2018.
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three children missing immunization.
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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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2018
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: GAN SHELANU PRESCHOOL CENTER
FACILITY NUMBER: 197415614
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2018
Section Cited
HSC
1596.7995
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Employees or volunteers at day care center; immunization requirements; records; exemptions.

The requirement is not met as evidenced by record review of 5 staff including the Director.
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Per Licensee, she will have her staff including the licensee to obtain proof of immunizations and maintain a copy on file. A copy of the immunization record will be submitted to LPA by POC due date of 09/21/2018.
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Director and Staff are missing proof of Pertussis, Influenza, and Measles vaccine. This poses a potential risk to the health and safety of children in care.
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Type B
09/21/2018
Section Cited
CCR
101216.1(g)
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Teacher Qualifications and Duties. The requirement is not met as evidenced by staff record review of staff #1 & #4 missing transcripts. One staff identified as a lead teacher did not have transcripts verifying completion of 12 CD/ECE units. Per Title 22 Regulations, a photocopy of the
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The licensee will ensure all teachers have verification of education on file at the facility. A copy of the verificaiton of education will be submitted toLPA by POC due date of 09/21/2018.
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teacher’s Child Development Permit or transcript(s) as specified shall be maintained at the child care center.
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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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2018
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: GAN SHELANU PRESCHOOL CENTER
FACILITY NUMBER: 197415614
VISIT DATE: 09/07/2018
NARRATIVE
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LPA reviewed 5 staff files including the director's files. All 5 staff that were present during the inspection, were missing immunization, and staff #1 and #4 were missing transcripts. Licensee was not able to provide LPA with the transcripts to review during the inspection.

At the time of the Plan Of Correction visit the facility was found to be in substantial compliance for the deficiencies cited on 08/30/2018, however the facility was not in substantial compliance during today's inspection when reviewing children's files and staff files. Type B violations was cited during today's inspection for missing immunization record for the children, and missing immunization for 5 staff, and missing transcripts for staff #1 and #4.

Licensee is advised to attend Orientation for Child Care Center for Record Keeping by the end of October 2018. Licensee to provide a copy of the certificate for the Record Keeping to LPA no later than October 2018.

Appeal rights were printed and provided to licensee during today's visit.
Exit interview was conducted and copy of report was provided.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Marina PilossianTELEPHONE: (424) 301-3065
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2018
LIC809 (FAS) - (06/04)
Page: 4 of 4