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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408229
Report Date: 11/15/2023
Date Signed: 11/15/2023 03:20:18 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
10/30/2023 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20231030111335
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:18CENSUS: 9DATE:
11/15/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Marla MedwinTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Limitations on Capacity - Commingling infants and preschoolers
INVESTIGATION FINDINGS:
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On 11/15/23 Licensing Program Analysts (LPAs) Monica Mathur and Brindha Govindasamy conducted an unannounced Subsequent Complaint Investigation at Gan B'Nai Shalom at Congregation B'Nai Shalom, met with Director, Marla Medwin and explained purpose of investigation. Complainant alleges that facility is commingling infants and preschoolers. During course of investigation LPAs conducted facility inspection, observations, record review, interviews and obtained documents. It was determined that there have been multiple occasions where children from preschool program were commingled with infants at end of the day and/or during staff shortages. This poses a potential risk to health and safety of children in care. Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page. Licensee is reminded that facility must operate within limitations and capacity of license at all times. Exit interview was conducted with Director, Marla Medwin. A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
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-20231030111335
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: GAN B'NAI SHALOM AT CONGREGATION B'NAI SHALOM
FACILITY NUMBER: 073408229
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/25/2023
Section Cited
CCR
101161(a)
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101161 Limitations on Capacity (a) A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.This requirement is not met as evidenced by:
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By POC Due Date 11/25/23 Director agreed to submit a written plan on how they will stay in compliance with regulation moving forward.
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Per investigation, there have been multiple occasions where children from preschool program were commingled with infants at end of the day and/or during staff shortages. This poses a potential risk to health and safety of children in care.
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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: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2