010209547-10-30-2019-52-CC-AEVS-BJ6UPM-20191122144543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 010209547
Report Date: 10/30/2019
Date Signed: 10/30/2019 12:06:31 PM

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 STE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2019 and conducted by Evaluator Dayna Collier

PUBLIC

COMPLAINT CONTROL NUMBER: 52-CC-20191028111246

FACILITY NAME:	BETH SHOLOM PRESCHOOL		FACILITY NUMBER:	010209547
ADMINISTRATOR:	DANEK, SUSAN L		FACILITY TYPE:	850
ADDRESS:	642 DOLORES AVENUE		TELEPHONE:	(510) 357-8505
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	49	CENSUS: 37	DATE:	10/30/2019
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Susan Danek		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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PHYSICAL PLANT: Outdoor play area is hazardous to children in care.

INVESTIGATION FINDINGS:

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LPA Dayna Collier met with Center Director Susan Danek for a complaint investigation. There were 9 staff members supervising 37 children in care. It was alleged that tree stumps, tools and unleveled ground are posing a risk to children in care. LPA toured the facility and play yard. During the course of the investigation, interviews were conducted. There has been construction taking place in the outdoor play area which include adding tree stumps to the space. Per staff, children have been able to use the stumps safely and deny that children have been injured due to the tree stumps, holes or ditches on the yard. Staff stated that the playground was closed for one week while most of the construction was taking place. Per director, there have been workers present on the play ground while children were playing in other areas that were deemed "open" for play. Although the workers may have been using tools, there is no evidence to proven or disproven that children had access to tools left laying around. Based on the investigative findings, it cannot be proven or disproven whether the children had access to any area in the yard that was hazardous while the areas were under construction, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation is unsubstantiated..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna Collier	TELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

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 5

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 STE 1102
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2019 and conducted by Evaluator Dayna Collier

PUBLIC

COMPLAINT CONTROL NUMBER: 52-CC-20191028111246

FACILITY NAME:	BETH SHOLOM PRESCHOOL		FACILITY NUMBER:	010209547
ADMINISTRATOR:	DANEK, SUSAN L		FACILITY TYPE:	850
ADDRESS:	642 DOLORES AVENUE		TELEPHONE:	(510) 357-8505
CITY:	SAN LEANDRO	STATE: CA	ZIP CODE:	94577
CAPACITY:	49	CENSUS: 37	DATE:	10/30/2019
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Susan Danek		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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9

FOOD SERVICE: Dishes and utensils are not cleaned and sanitized.

INVESTIGATION FINDINGS:

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LPA Dayna Collier met with Center Director Susan Danek for a complaint investigation. There were 9 staff members supervising 37 children in care. It was alleged that the dishes that children use are being washed in water that is not hot. During the inspection, LPA ran the hot water which did not get hot. There were paper cups available for children to use to drink milk and plastic plates to serve snack. Per director, the dish washer is out of order and the facility is raising money to repair it. Children bring lunches and water bottles from home; snacks are provided twice a day by the facility. Based on the LPA's observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter Number 101227), is being cited on the attached LIC 9099D.
An exit interview was conducted and the report was discussed. Licensee was provided a copy of their appeal rights (LIC 9058 12/15) and the signature on this form acknowledges receipt of these rights.

A site visit notice was posted by Director.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna Collier	TELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

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 5

Control Number 52-CC-20191028111246

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 STE 1102
OAKLAND, CA 94612

FACILITY NAME: BETH SHOLOM PRESCHOOL	FACILITY NUMBER: 010209547
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/30/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/06/2019 Section Cited CCR 101227(a)(21)(B)	1 2 3 4 5 6 7	101227 Food Services (B) Centers not using dishwashing machines shall clean and sanitize dishes and utensils by an alternative comparable method. This requirement is not met as evidenced by LPA's observation and interviews conducted. This poses a potential risk to the health of children in care.	1 2 3 4 5 6 7	POC: Per director, there is an ample supply of paper plates that will be used immediately when serving food to children.
	8 9 10 11 12 13 14	THE WATER AT THE KITCHEN SINK USED TO WASH DISHES USED BY CHILDREN IS NOT GETTING HOT.	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.

SUPERVISOR'S NAME: Diane Perez	TELEPHONE: (510) 622-2590
LICENSING EVALUATOR NAME: Dayna Collier	TELEPHONE: (510) 725-7021
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2019

LIC9099 (FAS) - (06/04)

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