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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005166
Report Date: 07/07/2023
Date Signed: 07/07/2023 04:38:15 PM

Document Has Been Signed on 07/07/2023 04:38 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCHFACILITY NUMBER:
372005166
ADMINISTRATOR:FRAN FORMANFACILITY TYPE:
850
ADDRESS:4126 EXECUTIVE DRIVETELEPHONE:
(858) 362-1171
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 241TOTAL ENROLLED CHILDREN: 241CENSUS: 124DATE:
07/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Fran FormanTIME COMPLETED:
04:50 PM
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On 7/7/23 at 11:00 AM, Licensing Program Analysts (LPAs) Keturah Lane and Sherlynn Banas visited the facility to conduct an unannounced annual inspection. Upon arrival LPAs met with Director Fran Forman and proceeded to tour the facility.

LPAs observed a total of 124 children in care (including 12 toddlers):
Classroom #1: 10 children with staff members Manesha Nalwaya and Gabby Siperstein
Classroom #2: 8 children with staff members Sandra Jabarri and Joelma Glassman
Classroom #3: 6 toddlers with staff members Carol Marsh and Nelcy Giles
Classroom #4: 6 toddlers with staff members Veronica Camacho and Brent Levy
Classroom #5: 7 children with staff members Gerica Gaddis and Neta Kelly
Classroom #6: 4 children with staff members Ari Ellman and Angelina Rodriguez
Classroom #7: 13 children with staff members Kristin Rush and Alicia Richmond
Classroom #8: 11 children with staff members Nathalie Tello and Anna Siperstein
Classroom #9: 7 children with staff members Wendy Aguilar and Jessica Ortiz
Classroom #10: 10 children with staff members Valerie Bursey and Madison Smith
Classroom #11: 9 children with staff members Otoe Takahashi and Hilda Grassi
Classroom #12: 8 children with staff members Deborah Ruiz and Nevaeh Boschta
Classroom #13 was closed and not in use
Classroom #14: 13 children with staff members Margarita Dujowich and Ximena Maldonado
Classroom #15: 12 children with staff members Tatiana Arkhipov and Nicole Snyder

Appropriate ratios and capacity were observed. Appropriate care & visual supervision were also observed during the inspection while children were engaged in classroom activities and playing outside on the playgrounds. (continued on LIC809-C...)
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCH
FACILITY NUMBER: 372005166
VISIT DATE: 07/07/2023
NARRATIVE
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Furniture and age-appropriate equipment is in good condition. Rooms have adequate heating, lighting, ventilation. Floors appear to be clean and safe. Drinking water is readily accessible. Bathrooms are maintained with operational toilets and faucets with appropriate temperature. Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. Food service area consists of a kitchen which is clean and free of hazards. Menu is posted. Adequate food is available for meals. Children bring lunches from home. Cleaning supplies are kept separate from food and are inaccessible to children. Storage containers for solid waste have tight-fitting covers and are kept in good repair. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 F or less. The facility appears to be free of insects and rodents. There is an operational carbon monoxide detector at the facility. Last emergency drill was conducted on 2/23/23.

Outdoor play areas are fenced playgrounds (2) with sufficient material for cushioning. Climbing structures, swings and slides are securely fixed to the ground. Area has canopies used for shade. Equipment is age appropriate (ages 2-12 years – sticker on structure). There are no bodies of water in the licensed area, however the facility has swimming pools in the unlicensed areas for the community center used for the preschool children during the summer months. The swimming pools are on opposite side of the building away from the licensed areas. Preschool children are escorted by qualified teachers (teachers stay with the children during swimming time) and lifeguards are available in the pool. Facility only uses the pool during the summer months. Children go swimming 3 times a week. The pool for the younger children is fenced. Area has drinking water readily accessible, and grounds are free of debris or potential hazards.

LPA reviewed medication storage. LPA observed one child (C1) with an epi-pen with no prescription label. Personnel records contain health screening documentation and at least one staff member has current CPR and First Aid certifications. Two staff members (S2 and S3) did not have immunizations to pertussis or measles available in file for review. Two staff members (S1 & S2) had expired mandated reporter certificates. Each personnel record contains documentation of educational background and training. Sign ins were reviewed. (continued on LIC809-C...)
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
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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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCH
FACILITY NUMBER: 372005166
VISIT DATE: 07/07/2023
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Children’s records contain admission agreements and medical assessment. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Toddler program is kept separate from preschool program at all times. Sleep logs for toddlers were reviewed.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPAs verified that the lead testing was completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Facility representative was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. (continued on LIC809-C...)
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCH
FACILITY NUMBER: 372005166
VISIT DATE: 07/07/2023
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

For IMS information see PIN 22-02-CCP. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication. Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Pursuant to Title 22 of the CA Code of Regulations, the following Type B deficiencies were cited (refer to LIC 809-D).

Exit interview conducted and report was reviewed with facility representative Director Fran Forman. A notice of site visit was given and must remain posted for 30 days.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2023 04:38 PM - It Cannot Be Edited


Created By: Keturah Lane On 07/07/2023 at 03:59 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCH
FACILITY NUMBER: 372005166

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(1)(B)
Health-Related Services
(e) In centers where the licensee chooses to handle medications: (1) All prescription and nonprescription medications shall be centrally stored in accordance with the requirements specified below: (B) Each container shall have an unaltered label.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observations, the licensee did not comply with the section cited above in one out of two children which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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Director stated she would obtain prescription for child's epi-pen and e-mail proof to LPA by 7/28/23 to:Keturah.Lane@dss.ca.gov
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out 15 staff records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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Director stated she would send completed mandated reporter certificates for staff members (S1) and (S2) by 7/28/23 via e-mail to: Keturah.Lane@dss.ca.gov
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:Tashima Daniel
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/07/2023 04:38 PM - It Cannot Be Edited


Created By: Keturah Lane On 07/07/2023 at 03:59 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
, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: JEWISH COMMUNITY CENTER; M. LARRY LAWRENCE BRANCH
FACILITY NUMBER: 372005166

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in two out of 15 staff records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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Director stated she would provide proof of immunizations to pertussis and measles for staff members (S2) & (S3) by 7/28/23 via e-mail to: Keturah.Lane@dss.ca.gov.
Director also stated she would send proof of immunization (or declination) to influenza for all staff members.
Deficiency Dismissed
Type B
Section Cited
CCR
101221(b)(8)(C)
Child's Records
(C) A signed consent form for emergency medical treatment unless the child's authorized
representative has signed the statement specified in Section 101220(f).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in all 8 children's records reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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Director stated she would obtain signed emergency consent forms (LIC627) for all children enrolled and put in the child records. Director will send a sample of the completed forms to LPA Lane by 7/28/23 via e-mail to Keturah.Lane@dss.ca.gov
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:Tashima Daniel
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2023


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