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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408229
Report Date: 02/09/2024
Date Signed: 02/09/2024 04:03:23 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
12/06/2023 and conducted by Evaluator Christina Watts
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20231206104720
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: 8DATE:
02/09/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marla MedwinTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are not labeling breast milk bottles for infants.
INVESTIGATION FINDINGS:
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On 02/09/2024 at 1:00 PM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced Subsequent Complaint Investigation at Gan B'Nai Shalom at Congregnation B'Nai Shalom. LPA met with Director, Marla Medwim and explained the purpose of today’s inspection. During today's inspection, there were 8 infant children in care with 4 staff in two classrooms and Director stated there are 12 infant children enrolled. The finding for the above allegation was delivered during the inspection. Complainant alleges that Staff are not labeling breast milk bottles for infants. During the course of the investigation, LPA inspected the facility, reviewed records and conducted interviews. LPA did observed 1 infant bottle without a label. It was determined that facility had prior occurrences when bottles were not labeled. 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. Exit interview was conducted with Director, Marla Medwim. Appeal rights were provided.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECTIVE DAYS.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
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 3
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
12/06/2023 and conducted by Evaluator Christina Watts
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20231206104720

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:12CENSUS: 8DATE:
02/09/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marla MedwinTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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2
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9
Staff are accepting sick children into care
INVESTIGATION FINDINGS:
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On 02/09/2024 at 1:00 PM, Licensing Program Analyst (LPA) Christina Watts conducted an unannounced Subsequent Complaint Investigation at Gan B'Nai Shalom at Congregnation B'Nai Shalom. LPA met with Director, Marla Medwim and explained the purpose of today’s inspection. During today's inspection, there were 8 infant children in care with 4 staff in two classrooms and Director stated there are 12 infant children enrolled. The finding for the above allegation was delivered during the inspection. Complainant alleges that Staff are accepting sick children into care. During the course of the investigation, LPA completed a physical plant inspection, reviewed facility records and conducted interviews. LPA could not determined at this time if facility accepts sick children into care. Based on the interviews and information obtained throughout the investigation, the allegation is UNSUBSTANTIATED which means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Deficiency has been cited for this allegation. Exit interview conducted with Director, Marla Medwin. Appeal rights were provided.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 CONSECTIVE DAYS.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
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 3
Control Number 02-CC-20231206104720
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: 02/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
CCR
101427(j)
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101427 Infant Care Food Service (j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date. This requirement has not been met as evidenced by:
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By 02/09/2024, Director stated they will submit a written statement on how facility will come back into compliance. Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.
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Based on observation and interviews, the licensee did not comply with the section cited above when infant bottles were not labeled which poses an potential risk to the health, safety or personal rights 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: Christina Watts
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3