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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 010209547
Report Date: 01/16/2020
Date Signed: 01/16/2020 03:35:11 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
12/23/2019 and conducted by Evaluator Briana Plumboy
COMPLAINT CONTROL NUMBER: 52-CC-20191223162621
FACILITY NAME:BETH SHOLOM PRESCHOOLFACILITY NUMBER:
010209547
ADMINISTRATOR:DANEK, SUSAN LFACILITY TYPE:
850
ADDRESS:642 DOLORES AVENUETELEPHONE:
(510) 357-8505
CITY:SAN LEANDROSTATE: CAZIP CODE:
94577
CAPACITY:49CENSUS: 34DATE:
01/16/2020
UNANNOUNCEDTIME BEGAN:
02:02 PM
MET WITH:Susan DanekTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Physical Plant- Facility is not free from hazards.
INVESTIGATION FINDINGS:
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On 01/16/20, LPAs Plumboy and Chen met with Director Susan Danek for a complaint investigation regarding the above allegation. Present during the inspection was 34 children in care and 6 fingerprint clear and associated staff.
During the course of the investigation, LPAs toured the facility and observed chairs being stacked which were a potential height that would be unsafe for the daycare children in the main hall where children have activities, nap, and eat. Based on observations, interviews 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 is being cited on the attached LIC 9099D. A Notice of Site visit was provided and must remain posted for 30 days. This report must remain on file for 3 years. Exit interview conducted with Susan Danek. Copy of report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
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 52-CC-20191223162621
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: 01/16/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2020
Section Cited
CCR
101223(a)(2)
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101223(a)(2): The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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During the inspection, Director has cleared the deficiency by removing hazards away from area.
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This was met by: based on observation. LPA toured the facility and noticed that daycare room has hazards that is a potential health and safety risk to children in care.
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Failure to correct will result in $100 per day civil penalty. Repeat violations are $250 per violation and $100 per day until corrected.
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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: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Briana PlumboyTELEPHONE: (510) 725-7005
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
LIC9099 (FAS) - (06/04)
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