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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215802
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:30:45 PM

Document Has Been Signed on 08/26/2021 01:30 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, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:TEMPLE ADAT ELOHIM, GALLANT-SCHIFF INFANT CENTERFACILITY NUMBER:
566215802
ADMINISTRATOR:DONNA BECKERFACILITY TYPE:
830
ADDRESS:2420 EAST HLLCREST AVENUETELEPHONE:
(805) 497-6920
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Donna BeckerTIME COMPLETED:
01:45 PM
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On August 26, 2021 at 12:31 pm, Licensing Program Analyst (LPA) Francisco Pedroza conducted an unannounced Annual/Random inspection. LPA met with facility Director Donna Becker and advised her the purpose of the inspection. There was two (2) children in care at the time of the inspection. The facility operates Monday thru Friday 7:30 am - 6:00 pm. The facility also has an preschool program on the premises as well.

LPA observed required licensing documents mounted on the wall in each classroom. There was no menu posted. There were three (3) staff supervising two (2) infants in the classroom. The classroom had age appropriate toys and furnishings. LPA observed the classroom had a changing table with sink readily accessible. LPA observed enough cribs for the infants in care. Facility had the required and current sleep logs on the wall. Food and milk is stored within a refrigerators located in the classroom. LPA reviewed a sampling of Individual needs & services plans and feeding plans. Facility routinely update the needs and services plans for the children and post it on the refrigerator. Children bottles and food were properly labeled with child's name and date. LPA did not observe any toxins/hazardous items accessible to children.

Continued on 809C
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: TEMPLE ADAT ELOHIM, GALLANT-SCHIFF INFANT CENTER
FACILITY NUMBER: 566215802
VISIT DATE: 08/26/2021
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A sampling of children and staff records were reviewed. Teachers have required qualifications. Teachers present have current Pediatric First Aid/CPR certificates that expire on 8/9/2023. Teachers present have current AB 1207 Mandated Reporter Training certificates that expire on 1/11/2022. LPAs verified SB 792 Child Care Adult Immunization and Tuberculosis Requirements. Facility is follow current Covid-19 and Safe Sleep guidelines.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

No deficiencies were cited during today's visit.



THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY.
SUPERVISORS NAME: George Mingle
LICENSING EVALUATOR NAME: Francisco Pedroza
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
LIC809 (FAS) - (06/04)
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