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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 566215802
Report Date: 11/15/2024
Date Signed: 11/15/2024 03:27:51 PM

Document Has Been Signed on 11/15/2024 03:27 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:TEMPLE ADAT ELOHIM, GALLANT-SCHIFF INFANT CENTERFACILITY NUMBER:
566215802
ADMINISTRATOR/
DIRECTOR:		DONNA BECKERFACILITY TYPE:
830
ADDRESS:2420 EAST HLLCREST AVENUETELEPHONE:
(805) 497-6920
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
11/15/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Lindsay WozniakTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 11/15/2024 @ 10:00, Licensing Program Analyst (LPAs) Veronica Diaz and Sylvia Ceja conducted an unannounced Required-3 Year inspection. LPAs met with director Lindsay Wozniak and advised them of the purpose of the inspection. Director provided LPAs a tour of the facility inside and out. There were 9 infants in care at the time of the inspection along with 4 staff. Center operates M-F 7:30 AM-5:30 PM.

LPAs observed required licensing documents mounted on the walls throughout the facility. Last disaster drill was conducted on 10/22/24. Each of the classrooms have age-appropriate toys and furniture readily accessible for children in care. LPAs observed changing table arms reach to sink with dippers, wipes, and gloves labeled with each infants name in cubbies. LPAs observed feeding, eating, sleeping, and changing logs being conducted and documented. LPAs did not observe any hazards/toxins items accessible to infants. First Aid kits were observed in backpack near classroom door and also stored in cabinet near classroom sink. Currently the facility uses an App called Brightwheel for parents sign-in and sign-out and a form of communication to parents. Parents provide milk, food, and snacks from home. Infant milk and food was stored individual containers in the refrigerator labeled with infants name.

The outdoor playground is shaded and has plenty amount of space for infants to play. LPA observed the playground has age-appropriate toys and structures available for infants.

A sampling of children and staff records were reviewed. LPAs observed infant files to be incomplete missing Individual Sleep Plan and 1 immunization record. Staff mandated reporter certification were expired LPAs reminded director staff are required to complete mandated reporter training every 2 years. LPAs verified SB792 Child Care Adult Immunization and Tuberculosis requirements.

Continued on 809-C
SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: TEMPLE ADAT ELOHIM, GALLANT-SCHIFF INFANT CENTER
FACILITY NUMBER: 566215802
VISIT DATE: 11/15/2024
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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.

Director 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 child care 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).
LPA verified that the lead testing was completed on 08/03/2022 in accordance to the Written Directives outlined in PIN 21-21.1-CCP.



SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
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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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME: TEMPLE ADAT ELOHIM, GALLANT-SCHIFF INFANT CENTER
FACILITY NUMBER: 566215802
VISIT DATE: 11/15/2024
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LPA discussed the safe sleep regulations with director 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 director 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.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. 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) 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/.

Director was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.


A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In today's visit the was 1 type B deficiency and 3 Technical Violations

Exit interview conducted, appeal rights were given, and report was reviewed with director Lindsay Wozniak.

SUPERVISORS NAME: Lissete Gonzalez
LICENSING EVALUATOR NAME: Veronica Diaz
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024
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Document Has Been Signed on 11/15/2024 03:27 PM - It Cannot Be Edited


Created By: Veronica Diaz On 11/15/2024 at 02:19 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
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: TEMPLE ADAT ELOHIM, GALLANT-SCHIFF INFANT CENTER
FACILITY NUMBER: 566215802

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101416.5(b)(1)(A)
Staff-Infant Ratio
(b) There shall be a ratio of one teacher for every four infants in attendance. (1) An aide may be substituted for a teacher when all of the following conditions are met: (A) There is a fully qualified teacher directly supervising no more than 12 infants, and

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/13/2024
Plan of Correction
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Director will submit infant center coverage who is fully qualified teacher to LPA by email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lissete Gonzalez
LICENSING EVALUATOR NAME:Veronica Diaz
LICENSING EVALUATOR SIGNATURE:
DATE: 11/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/15/2024


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