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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010209547
Report Date: 06/19/2024
Date Signed: 06/19/2024 05:02:43 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2024 and conducted by Evaluator Michael Mathew
COMPLAINT CONTROL NUMBER: 52-CC-20240501160218
FACILITY NAME:BETH SHOLOM PRESCHOOLFACILITY NUMBER:
010209547
ADMINISTRATOR:CHASE, AMANDAFACILITY TYPE:
850
ADDRESS:642 DOLORES AVENUETELEPHONE:
(510) 357-8505
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:49CENSUS: DATE:
06/19/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Amanda ChaseTIME COMPLETED:
05:05 PM
ALLEGATION(S):
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Facility is in disrepair
INVESTIGATION FINDINGS:
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 On 6/19/24 at 8:30 AM Licensing Program Analysts (LPA) Michael Mathew conducted an unannounced inspection to conclude a complaint investigation. LPA met with Director Amanda Chase and advised her the purpose of the inspection. Director provided LPA a tour of the facility inside and out. There were 30 children and 9 staff in care at the time of the inspection.

Based on LPAs observation and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation of Facility is in disrepair. is found to be SUBSTANTIATED.California Code of Regulations, Title 22, Division 12 Chapter 1 Article 07.section 101238(a) Buildings and Grounds are being cited on the attached LIC 9099D.

A notice of site visit and appeal rights were given. Exit interview conducted and report was reviewed with Director Amanda Chase
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 52-CC-20240501160218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BETH SHOLOM PRESCHOOL
FACILITY NUMBER: 010209547
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2024
Section Cited
HSC
101238(a)
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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.
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Director agreed to send record of completion to LPA Via email by Friday 6/21/24
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Based on observation and interview. Staff and parents have stated there was construction that was going on during the hours of operation. LPA observed cones on the roof of the building indicating that work was being done on the roof.
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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.
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/01/2024 and conducted by Evaluator Michael Mathew
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20240501160218

FACILITY NAME:BETH SHOLOM PRESCHOOLFACILITY NUMBER:
010209547
ADMINISTRATOR:CHASE, AMANDAFACILITY TYPE:
850
ADDRESS:642 DOLORES AVENUETELEPHONE:
(510) 357-8505
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:49CENSUS: DATE:
06/19/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Amanda ChaseTIME COMPLETED:
05:05 PM
ALLEGATION(S):
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9
Staff did not ensure comfortable accommodations were provided to children in care
INVESTIGATION FINDINGS:
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This is an amended report from the original findings that was delivered on 6/19/2024.

On June 19,2024 at, 8:25 AM Licensing Program Analyst (LPA) Michael Mathew conducted an unannounced complaint investigation to delivery the amended findings. LPA met with Director Amanda Chase and advised her the purpose of the inspection. LPA toured the facility inside and out. There were 19 children and 9 staff in care at the time of the inspection.

During the investigation, LPA interviewed staff members and parents. Based on interviews conducted, record review and LPA's obeservation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.Therefore, the allegations is deemed UNSUBSTANTIATED.

A notice of site visit and appeal rights were given. Exit interview conducted and report was reviewed with Director Amanda Chase
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wynn Norona
LICENSING EVALUATOR NAME: Michael Mathew
LICENSING EVALUATOR SIGNATURE:

DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3