<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408229
Report Date: 08/28/2024
Date Signed: 08/28/2024 04:32:13 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 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
07/10/2024 and conducted by Evaluator Tasha Hackett-Alexander
COMPLAINT CONTROL NUMBER: 02-CC-20240710161133
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: 3DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:STEPHANIE MACHADOTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
PERSONAL RIGHTS- The facility is allowing minors to care for infants
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On August 28, 2024, Licensing Program Analyst (LPA) Tasha Alexander met with interim director Stephanie Machado and Consultant Leah Rosenthal-Kambik to deliver the findings to the above complaint allegation.

Upon arrival, there are 3 infants present along with 1 teacher and 1 aide. During this analyst's last visit, interviews were conducted with staff, a tour of classrooms was conducted and documents were requested and received. Further investigation has been conducted and it was found that the previous director allowed her minor children (ages 11 and 13 years old) to be present and help care for infants in the infant room.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

California Code of Regulations, Title 22, Division 12 & Chapter 1, are being cited on the attached LIC. 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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 4
Control Number 02-CC-20240710161133
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 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: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2024
Section Cited
CCR
101223(a)(2)
1
2
3
4
5
6
7
101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
1
2
3
4
5
6
7
Per administrator and interim director, the previous director is no longer employed with the facility.
The director will submit a summary detailing new classroom policies/rules and age requirements for the infant classroom by 9/11/24
8
9
10
11
12
13
14
THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY:interviews and records records review which revealed the previous director's minor children were allowed to be present and help out in the infant classroom
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 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
07/10/2024 and conducted by Evaluator Tasha Hackett-Alexander
COMPLAINT CONTROL NUMBER: 02-CC-20240710161133

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: 3DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:STEPHANIE MACHADOTIME COMPLETED:
04:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
REPORTING REQUIREMENT- The facility did not report diarrhea outbreak to Licensing or parents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On August 28, 2024 Licensing Program Analyst (LPA) Tasha Alexander met with Interim director Stephanie Machado and Consultant Leah Rosenthal-Kambik to deliver the findings to the above complaint allegation.

Upon arrival there are 3 infants present along with 1 teacher and 1 aide. During this analyst's last visit, interviews were conducted with staff, a tour of classrooms was conducted and documents were requested and received. Further investigation has been conducted.

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

California Code of Regulations, Title 22, Division 12 & Chapter 1, are being cited on the attached LIC. 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 02-CC-20240710161133
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 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: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/04/2024
Section Cited
CCR
101212(a)(2)(a)
1
2
3
4
5
6
7
101212 Reporting Requirements
(a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following:
2) Title 17, Section 2500, lists the following reportable communicable diseases as of March 21, 1997:
(A) Communicable Diseases:
1
2
3
4
5
6
7
The facility will submit an unusual incident injury report form to report the outbreak of diarrhea at the facility by 9/4/24. In the future, the facility will be sure to report any unusual incident within 24 hours of the incident happening and any communicable diseases within 10 days to community care licensing.
8
9
10
11
12
13
14
THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY: A review of records which revealed the facility did not report an outbreak of diarrhea to Community Care Licensing.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4