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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010209547
Report Date: 08/16/2019
Date Signed: 08/16/2019 11:42:51 AM

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 STE 1102
OAKLAND, CA 94612
FACILITY NAME:BETH SHOLOM PRESCHOOLFACILITY NUMBER:
010209547
ADMINISTRATOR:VAKNIN, EDNA SHABETAYFACILITY TYPE:
850
ADDRESS:642 DOLORES AVENUETELEPHONE:
(510) 357-7920
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:49CENSUS: 24DATE:
08/16/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Susan L. DanekTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst, (LPA), R. Hollie, met with current Director, Susan L. Danek, for the purpose of a Case Management Health and Safety Inspection. As tour of the facility was conducted. There are 24 children along with seven staff present. All seven staff present are fingerprint cleared. During the initial start of the visit while meeting with the Director, a parent, Beth Zygielbaum, who does not work for the preschool, but is the Interim Director of the Temple Operations, spoke to LPA about the construction of a ramp being completed outside of the kitchen area. During today's this visit, there is no construction, however, there is a large dumpster in front of the building where debris is being placed. There has been no construction or renovation of the inside of the day care. Upon conducting the tour of the facility, LPA observed that the sign in and sign out is not being properly signed. Additionally, LPA observed that the facility has closed the kitchen doors that were being used as a walk thru for children to go from the Gimmel classroom to the Bett classroom. The facility closed the doors at the request of the Fire Department, however, the facility did not contact Community Care Licensing regarding the required changes of ramp or doors. PLEASE SEE THE 809-D FOR TYPE B DEFICIENCIES REGARDING ALTERATIONS AND SIGN IN AND SIGN OUT.
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: BETH SHOLOM PRESCHOOL
FACILITY NUMBER: 010209547
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/16/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2019
Section Cited
CCR
101237a
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101237 Alterations to Existing Buildings or New Facilities (a) Prior to construction or alterations, the licensee shall notify the Department of the proposed change(s). THIS REQUIREMENT IS NOT BEING MET.
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The facility will, in the future, submit in writing all changes to Community Care Licensing PRIOR to making changes.
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The facility was required by the Local Fire Department to build a ramp off of the kitchen area and close the kitchen doors that were used as a walk thru for children and did not report the changes as required.
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Type B
08/30/2019
Section Cited
CCR
101229.1
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101229.1 SIGN IN AND SIGN OUT
(1) The person who signs the child in/out shall use his/her full legal signature and shall record the time of day.
THIS REQUIREMENT IS NOT BEING MET.
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The facility will place in writing a plan on how they will ensure parents will sign in using full legal signatures.
A copy of the written plan will be submitted to LPA no later than 08-30-19
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The facility is not ensuring that parents use full legal signatures as parent(s) are signing in with initials.
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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.
SUPERVISOR'S NAME: Anika EvansTELEPHONE: (510) 286-4350
LICENSING EVALUATOR NAME: Ronda HollieTELEPHONE: (510) 725-7004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2019
LIC809 (FAS) - (06/04)
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