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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010209547
Report Date: 12/12/2024
Date Signed: 12/12/2024 01:15:21 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
10/29/2024 and conducted by Evaluator Michael Mathew
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20241029132516
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: 40DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Amanda Chase TIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Rodents in the outdoor play yard
INVESTIGATION FINDINGS:
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On December 12,2024 at, 8:40 AM Licensing Program Analyst (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 40 children and 8 staff in care at the time of the inspection.

Based on LPA interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section: 101238(a)(1) 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: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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 5
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
10/29/2024 and conducted by Evaluator Michael Mathew
PUBLIC
COMPLAINT CONTROL NUMBER: 52-CC-20241029132516

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: 40DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Amanda Chase TIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Dirt and netting on outdoor play yard causing a tripping hazard for children
INVESTIGATION FINDINGS:
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On December 12,2024 at, 8:40 AM Licensing Program Analyst (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 40 children and 8 staff in care at the time of the inspection.

LPA interviewed staff members, parents, and reporting party.Based on interviews conducted,and observations,the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 07, Section: 101238.2 (d)(2) Physical Environment, 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: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 52-CC-20241029132516
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: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
CCR
101238.2(d)(2)
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101238.2 Physical Environment (d)The surface of the outdoor activity space shall be maintained:(2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.
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Director agreed to block off the area that the netting is showing. Director agreed to send picture of blocked area to LPA by end of day 12/20/24. Director also stated that she will be remove the grass area before 12/31/24. Director will send a picture to LPA of the removal of the grass.
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This requirement is not met as evidenced by, based on Interviews of reporting party and staff. Who have stated that they have observed staff tripping on wired mesh in the grass area. LPA also observed wire mesh by the grass area that is hazardous to children and staff.
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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: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 52-CC-20241029132516
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: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/31/2024
Section Cited
CCR
101238(a)(1)
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Section 101238 Buildings and Grounds, (a) the childcare 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, (1) the licensee shall take measures to keep the center free of flies, other insects, and rodents.....
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LPA discussed to the Director to review and facilitate the INTEGRATED PEST MANAGEMENT
https://cchp.ucsf.edu/sites/g/files/tkssra181/f/IPM_Guide_FCCH_0.pdf, on or before the POC due date. Director stated that she will contact executive director Beth to deep clean the playground. Director also stated that she will have the exterminator come to the facilty every other week and will provide recipts of visits. Director also agreed to send a proof of completion by end of day 12/31/2024
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This requirement is not met as evidenced by, based on Interviews of reporting party and staff. Who have stated that they have observed a rat running in the playground.
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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: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5