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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408229
Report Date: 10/11/2023
Date Signed: 10/11/2023 02:23:00 PM

Document Has Been Signed on 10/11/2023 02:23 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: 18TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
10/11/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Marla MedwinTIME COMPLETED:
02:00 PM
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On 10/11/23 Licensing Program Analysts (LPAs) Monica Mathur and Brindha Govindasamy conducted an unannounced Case Management inspection and met with Director, Marla Medwin and Executive Director, Stuart Kirsch to conduct an inspection for the Lead Testing results at the center.

Marla and Stuart informed one outlet exceeded the Action Level established by the State for exposure. It is located in the Office and not used by children for drinking or food preparation. Marla stated this outlet was never used by children. All outlets were tested for lead and none of those used by children had exceedance. The outlet in the office and is scheduled for retesting soon. The office staff has not been using the outlet either.

The lead exceedance did not pose a health and safety risk to children in care, therefore no deficiency is cited today. Present today at the center were 6 infants.

Exit interview conducted and report was reviewed with the Director, Marla Medwin. A Notice of Site Visit was given and must remain posted for 30 days..

SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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