304270714-5-7-2021-06-CC-RJCN-C2SQYW-20210507123549

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 304270714
Report Date: 05/07/2021
Date Signed: 05/07/2021 12:36:59 PM

Document Has Been Signed on 05/07/2021 12:36 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:	EARLY CHILDHOOD CENTER OF TEMPLE BETH EL		FACILITY NUMBER:	304270714
ADMINISTRATOR:	YESHARIM, WENDY		FACILITY TYPE:	850
ADDRESS:	2A LIBERTY		TELEPHONE:	(949) 394-2070
CITY:	ALISO VIEJO	STATE: CA	ZIP CODE:	92656
CAPACITY: 83	TOTAL ENROLLED CHILDREN: 0	CENSUS: 36	DATE:	05/07/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Wendy Yesharim - Program Director		TIME COMPLETED:	12:35 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Tele-Inspection due to Covid-19 State of Emergency On 05/07/21 Licensing Program Analyst (LPA), Ryan Chan conducted a case management inspection via Facetime due to an incident which was self-reported by the facility to the licensing office. LPA met with Program Director Wendy Yesharim via FaceTime application who guided LPA through a tour of the facility. LPA notified Program Director that due to Covid-19 and Department of Public Health (DPH) guidelines of social distancing a tele-inspection is conducted. There was a total of 36 preschool children with 6 staff at the facility. A review of the Facility Personnel Report Summary on 05/07/21 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. On 04/22/21 Program Director Wendy Yesharim called licensing to report an incident where a child fell from the bottom of the slide. The incident occurred on 04/21/21 at approximately 11:00am on the play structure. The Unusual Incident Report (UIR) form was received at the licensing office on 04/26/21. LPA interviewed 5 staff, reviewed the UIR, and the sign-in/sign-out sheets for both staff and children. Records reviewed reveal there were 23 total children on the play yard at the time of the incident. The children are from Group 1 and Group 2, each class has 2 teachers with a total of 4 teachers. Interviews revealed 2 of 4 teachers were coming back from their breaks and did not witness the incident occur which leaves 2 of 4 teachers with 23 children at the time of the incident. Of the 2 teachers left with the children at the time of the incident, 1 teacher stated being within the middle of the play structure where the subject child sustained injuries, the other teacher stated being on the other side of the play structure monitoring other children. Continued on page 2

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Ryan Joseph Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: EARLY CHILDHOOD CENTER OF TEMPLE BETH EL	FACILITY NUMBER: 304270714
	VISIT DATE: 05/07/2021

NARRATIVE

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Per interviews conducted teacher who was closest to subject child stated seeing subject child on top of the slide, teacher then looked away to pan and monitor other children. Teacher noticed subject child holding subject child’s arm but was not crying. Teacher went to ask subject child what was wrong which is when the injury was discovered. Program Director Wendy Yesharim was informed who came out to the play yard and escorted the subject child back into the facility, provided an ice pack, then called the subject child’s parents.

During the tour of the facility, LPA observed the play structure to be in good condition. The padding on the bottom of the play structure is of a rubberized material and is in good condition.

Based on staff interviewed, records reviewed, and LPA observations, this incident, where a child fell at the bottom of the slide on a play structure, is deemed to be an accident.

No deficiencies are cited during this inspection.

Exit interview was conducted. Appeal Rights was explained. A copy of appeal rights (LIC 9058 1/16) will be provided through email and their signatures on this form acknowledges receipt of these rights. (The "Read Receipt" or licensee's email is in lieu of a signature). First level appeal is to Regional Manager, address is above on the report.

SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Ryan Joseph Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021

LIC809 (FAS) - (06/04)

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