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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600675
Report Date: 10/18/2021
Date Signed: 10/18/2021 03:40:11 PM

Document Has Been Signed on 10/18/2021 03:40 PM - It Cannot Be Edited

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 BETH AM NURSERY SCHOOLFACILITY NUMBER:
191600675
ADMINISTRATOR:BASS, ANGIEFACILITY TYPE:
850
ADDRESS:1039 S LA CIENEGATELEPHONE:
(310) 652-7353
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY: 134TOTAL ENROLLED CHILDREN: 134CENSUS: DATE:
10/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Angie Bass - DirectorTIME COMPLETED:
01:07 PM
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On 10/18/2021 Licensing Program Analyst (LPA) Jillinda Chandler made a subsequent visit to the Temple Beth AM nursery school for the purpose of conducting an unannounced Annual Random inspection.

Upon arrival LPA Chandler was denied access to the school due the schools policy, all visitors must show proof of vaccination before entering the school while children are present.

On 10/12/2021 LPA and director Bass spoke regarding their school policy and the departments inspection authority, per director Bass it was understood regarding the type of inspection (unannounced) that is required and she would work it out.

Based on Health and Safety Code Section 1596.852 provides:
Any duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, this act or the regulations adopted by the department pursuant to the act.

Therefore the department has diligently attempted to conduct an on site inspection, and was denied entry.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2021
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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Document Has Been Signed on 10/18/2021 03:40 PM - It Cannot Be Edited


Created By: Jillinda Chandler On 10/18/2021 at 12:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: TEMPLE BETH AM NURSERY SCHOOL
FACILITY NUMBER: 191600675

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/18/2021
Section Cited
HSC
1596.852

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HS1596.852 Any duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and
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The center shall immediately comply with the departments regulations, failure to comply will result in additional penalties and/or adminstrative action. Licensee was informed that a copy of this report
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services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, this act or the regulations adopted by the department pursuant to the act.
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shall be posted in a prominent area, and with-in 24 hours or upon return of a child a copy shall be provided to all parents along with the LIC 9224 Acknowledgement of Licensing Reports

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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:Peter Flores
LICENSING EVALUATOR NAME:Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2021


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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: TEMPLE BETH AM NURSERY SCHOOL
FACILITY NUMBER: 191600675
VISIT DATE: 10/18/2021
NARRATIVE
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The licensee was advised that the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If facility was cited type A violations or complaint is found to be substantiated or unsubstantiated, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. Licensee must inform the parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months via form LIC-9224 Acknowledgement of Receipt of Licensing Reports.

A type "A" citation was issued and civil penalties assessed.

An exit interview was conducted, a copy of this report was provided along with the appeal rights

Representative/Director refuses signature.

SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
LIC809 (FAS) - (06/04)
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