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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300601652
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:56:59 PM

Document Has Been Signed on 08/26/2021 01:56 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:TEMPLE BETH DAVID PRE SCHOOLFACILITY NUMBER:
300601652
ADMINISTRATOR:BROOKE MASTROLUCAFACILITY TYPE:
850
ADDRESS:6100 HEFLEY STTELEPHONE:
(714) 893-3091
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 63TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
08/26/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Ms. Birdsall BrookeTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Ketki Desai conducted an announced Case Management Licensee initiated inspection for re-measuring room # 11, to accommodate 16 children, without changing the capacity of 63 children (2-6 years old) in the assigned 6 licensed room.
Several rooms are combined together and identified as one big room.
Rooms combined are as follows ( Room 1&2 / Room # 10 &11 / Room #12 & 13) This are three big rooms with two entrance doors but identified as one room.
Individual classrooms # are : 5 / 6 and 15.

In room # 10 & 11, facility made the changes by removing the wall in the room, giving them additional space. LPA measured this room on today's inspection.
Room # 11 is a combined room with two entrance doors, as room # 10 and 11 together and is identified as one big room on the school emergency map as Room # 11.

Indoor Measurements: Room # 11: 36'08 X 16 = 577'28 divided by 35= 16'49 (16 children)

With the additional of space (breaking the wall off) room # 11 can now accommodate 16 children as requested.

Appeal rights presented and a Notice of site visit was presented to the Director.

Exit interview conducted.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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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