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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408229
Report Date: 08/15/2023
Date Signed: 08/15/2023 03:42:54 PM

Document Has Been Signed on 08/15/2023 03:42 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GAN B'NAI SHALOM AT CONGREGATION B'NAI SHALOMFACILITY NUMBER:
073408229
ADMINISTRATOR:MEDWIN, MARLAFACILITY TYPE:
830
ADDRESS:74 ECKLEY LANETELEPHONE:
(925) 933-7633
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 0DATE:
08/15/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Marla MedwinTIME COMPLETED:
03:45 PM
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On 08/15/23, Licensing Program Analyst (LPA) Melissa Domantay arrived at the facility for an unannounced case management inspection for a change of capacity and adding a room. LPA met with Director, Marla Medwin. There were no children present during today's inspection. The normal hours of operation are Monday-Friday 7:30am-6:00pm. LPA conducted a full tour of infant classrooms, existing infant classroom, Classroom 5 and new infant classroom, Classroom 8, and outdoor infant play yard area to conduct a health and safety inspection. LPA observed 8 cribs during today's visit. The measurements are as follows:

INDOOR: 313.79 square feet = 8 children
OUTDOOR: remains the same as previous report measurements

A fire clearance was received from the Contra Costa County Fire Protection Department for 18 infants, ages birth to 24 months. Also on site, 65 preschoolers, two years to first grade entry, dated 8/2/2023.

Infant license for a capacity of 18 infants will be made part of the Infant License with a total capacity of 18 infant children with 8 cribs available for 8 crib aged infants is approved as of 8/15/23. There are no deficiencies being cited today. A Notice of Site inspection was provided to Director, Marla Medwin and an exit interview was conducted.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Melissa Domantay
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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