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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010210478
Report Date: 04/25/2023
Date Signed: 04/25/2023 02:45:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/02/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230302132218
FACILITY NAME:CONGREGATION BETH ISRAEL-GAN SHALOMFACILITY NUMBER:
010210478
ADMINISTRATOR:BALFOUR, BEATRICEFACILITY TYPE:
850
ADDRESS:2230-32 JEFFERSON STREETTELEPHONE:
(510) 848-3298
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:32CENSUS: 26DATE:
04/25/2023
UNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Emma SchnurTIME COMPLETED:
02:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Ratio
INVESTIGATION FINDINGS:
1
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3
4
5
6
7
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9
10
11
12
13
On April 25, 2023 at 12:46pm Licensing Program Analyst (LPA) Indira Loza met with Director Emma Schnur to conclude a complaint investigation. During today's visit LPA Loza conducted a walkthrough of the facility and observed the children.

Throughout the course of the investigation, LPA conducted interviews which indicated that staff were left alone with approximately 20 children on the playground. The preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22 is being cited on the attached LIC 9099-D.

The facility will be cited a Type A violation based on this substantiated allegation.
Report and Appeal Rights provided to Director Emma Schnur.
Notice of Site Visit must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/02/2023 and conducted by Evaluator Indira Loza
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230302132218

FACILITY NAME:CONGREGATION BETH ISRAEL-GAN SHALOMFACILITY NUMBER:
010210478
ADMINISTRATOR:BALFOUR, BEATRICEFACILITY TYPE:
850
ADDRESS:2230-32 JEFFERSON STREETTELEPHONE:
(510) 848-3298
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:32CENSUS: 26DATE:
04/25/2023
UNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Emma SchnurTIME COMPLETED:
02:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of Supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On April 25, 2023 at 12:46pm Licensing Program Analyst (LPA) Indira Loza met with Director Emma Schnur to conclude a complaint investigation. During today's visit LPA Loza conducted a walkthrough of the facility and observed the children.

Throughout the course of the investigation, the LPA conducted interviews which indicated that a child was left without supervision for an unspecified amount of time. The preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22 is being cited on the attached LIC 9099-D.

The facility will be cited a Type A violation based on this substantiated allegation.
Report and Appeal Rights provided to Director Emma Schnur.
Notice of Site Visit must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
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 4
Control Number 02-CC-20230302132218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CONGREGATION BETH ISRAEL-GAN SHALOM
FACILITY NUMBER: 010210478
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/26/2023
Section Cited
CCR
101229(a)(1)
1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision - (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation. This requirement was not met
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7
Director shall email the LPA staff acknowledgments for receiving a plan for ensuring all children are accounted for at all times (ex: adjusting schedules or increasing staff), and conduct a staff training no later than April 26, 2023.
8
9
10
11
12
13
14
as evidenced by: Based on interviews conducted, it was revealed that a child was left alone on the courtyard, which poses an immediate Health and Safety risk to the children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 02-CC-20230302132218
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CONGREGATION BETH ISRAEL-GAN SHALOM
FACILITY NUMBER: 010210478
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/26/2023
Section Cited
CCR
101216.3(a)
1
2
3
4
5
6
7
Teacher-Child Ratio: (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Director shall ensure there are enough staff at all times and conduct a staff training focusing on the ratio requirement and submit a staff acknowledgement agreement stating they have received the training.
8
9
10
11
12
13
14
Based on staff and children interviews, it has been determined that staff were left alone with approximately 20 children, which is an immediate Health and Safety risk to the children in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4