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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371107
Report Date: 07/05/2022
Date Signed: 07/05/2022 02:11:44 PM

Document Has Been Signed on 07/05/2022 02:11 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:HEBREW ACADEMYFACILITY NUMBER:
304371107
ADMINISTRATOR:PERELMUTER, CHANAFACILITY TYPE:
830
ADDRESS:14401 WILLOW LANETELEPHONE:
(714) 863-0757
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 10DATE:
07/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Chana Perelmuter, DirectorTIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nguyen Tran conducted an unannounced Case Management visit. LPA met with Director, Chana Perelmuter, to discuss the Lead Sampling Testing conducted on 05/17/22. Director was advised on 06/30/22 that the Lead Sample Report was to be posted. LPA confirmed that Director had posted the Lead Sample Report.

Director stated the outlets with high levels of lead are inoperable. They have made the faucets/outlets that tested with high levels oflLead inoperable via tape and sign "DO NOT USE" over the sink and faucets. The school will continue to provide Brita filtered pitcher for the staff and children.

Director stated they have contacted the Office of Water Program to inquire about fixing the identified outlets, and will re-test after fixing before put those outlets back into use.

Based on LPAs record reviews, the following violation was observed and is being cited in accordance with
California Code of Regulations Title 22, Division 12, Chapter 3, Section 101238(a) Buildings and Grounds is
being cited on the attached LIC 809D.

Exit interview conducted and report was reviewed with the facility representative Chana Perelmuter. A notice of site visit was given and must remain posted for 30 days.

Appeal Rights were explained. The Licensee was provided a copy of appeal rights (LIC 9058 01/16) and their
signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the
Regional Office within 15 business days. First level appeals should be sent to the regional manager to the
address listed above.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2022
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 07/05/2022 02:11 PM - It Cannot Be Edited


Created By: Nguyen K Tran On 07/05/2022 at 01:47 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: HEBREW ACADEMY
FACILITY NUMBER: 304371107

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/05/2022
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met evidenced by:
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Director posted the lead sampling test results. The water outlets were closed off with tape and sign "Do not use". Director stated they contacted the Office of Water Program to have a specific plan to fix the identified outlets/faucets and will retest and provide copies of the new test results to licensing office.
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Based on facility Lead sampling tests it was discovered that outlet in room P3 and Staff lounge had high level of lead. This poses a potential risk to the health of children in care.
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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:Rina Lopez
LICENSING EVALUATOR NAME:Nguyen K Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022


LIC809 (FAS) - (06/04)
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