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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010210478
Report Date: 07/13/2023
Date Signed: 07/13/2023 09:31:45 AM

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
06/21/2023 and conducted by Evaluator Ashley Curry
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20230621090315
FACILITY NAME:CONGREGATION BETH ISRAEL-GAN SHALOMFACILITY NUMBER:
010210478
ADMINISTRATOR:EMMA SCHNURFACILITY TYPE:
850
ADDRESS:2230-32 JEFFERSON STREETTELEPHONE:
(510) 848-3298
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:32CENSUS: 14DATE:
07/13/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Emma SchnurTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Child left in mudroom unsupervised
INVESTIGATION FINDINGS:
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On 07/13/2023 at 9:00 AM Licensing Program Analyst (LPA) A. Curry conducted an unannounced subsequent complaint inspection. LPA met with director, Emma Schnur, to discuss the above allegation. LPA previously conducted interviews, made observations, and retrieved documentation. During the course of the investigation, interviews revealed a child was left without supervision of a teacher. Based on the LPA’s interviews, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Violations of the California Code of Regulations, Title 22, Division 12, Section 101229 (a)(1) is being cited on the attached LIC 9099D. This is the second time the facility is being cited for Lack of Supervision within 12 months. Civil Penanlties will be assessed.

Exit interview conducted, appeal rights were given, and report was reviewed with the director Emma Schnur.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 02-CC-20230621090315
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: 07/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/14/2023
Section Cited
CCR
101229(a)(1)
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101229Responsibility for Providing Care and Supervision(a)The licensee shall provide care and supervision... (1)No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.

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By 07/14/2023 the director will submit a written plan on how she will ensure no child is left without supervision of a teacher at any time.
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This requirement was not met as evidence by:
Based on interviews the facility did not comply with the section cited above by ensuring all children are supervised by a teacher at all times. A child was left unsupervised in the mudroom.
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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: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3