073408229-8-4-2022-02-CC-MMAR-CGYT45-20220804142322

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073408229
Report Date: 08/04/2022
Date Signed: 08/04/2022 02:23:30 PM

Document Has Been Signed on 08/04/2022 02:23 PM - It Cannot Be Edited

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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	GAN B'NAI SHALOM AT CONGREGATION B'NAI SHALOM		FACILITY NUMBER:	073408229
ADMINISTRATOR:	MEDWIN, MARLA		FACILITY TYPE:	830
ADDRESS:	74 ECKLEY LANE		TELEPHONE:	(925) 933-7633
CITY:	WALNUT CREEK	STATE: CA	ZIP CODE:	94596
CAPACITY:	10	CENSUS: 4	DATE:	08/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Marla Medwin		TIME COMPLETED:	11:30 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/4/22 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Annual inspection at Gan B'Nai Shalom At Congregation B'Nai Shalom. LPA met with Staff, Ms Denise and Director, Marla Medwin and explained the purpose of today's inspection. Facility's operating days and hours are Monday to Friday 7:30 AM to 6:00 PM. Waiver on file to allow only 7 infants in infant play yard although center is licensed for 10 infants. Facility operates only in Room #5. There were no infants present in the room and Marla stated air conditioning is not working in the room and that portion of the building since 8/2/22 so they had to temporarily move 4 infants (1-2 year olds) into the preschool room #1 with 3 staff and 5 preschoolers (2 year olds). Infants were observed having snack at a separate table while preschoolers were playing and getting ready for their snack, all under the visual supervision of the staff. Infants do not take baby formula and are eating solids. Food storage areas were sanitary. Trash cans for solid waste had tight-fitting covers on and were in good repair. There is an infant changing table in Room 1 and all infants sleep on cots. Napping equipment is appropriate. Disinfectants, cleaning solutions, and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Cabinets, drawers, and rooms used for storage were locked. Floors were clean and free from tripping hazard. LPA observed a working fire extinguisher, smoke and carbon monoxide detectors. Outdoor Space: Outdoor activity space was inspected and observed to be safe. The play equipment is age appropriate and maintained in good condition and free of hazards. There were no bodies of water observed. File Review: Electronic Sign in system BRIGHT WHEEL is used. All Infant and Staff files was taken for review. LPA reviewed the Needs and Services Plan for all infants which were updated quarterly. Sleep Log requirements were discussed. They keep a log of when infant starts nap and when wakes up, but were unaware they need to log every 15 minutes. There was at least one Teacher with current certification in Pediatric CPR and First Aid present at the facility during inspection. A copy of Children Roster was obtained.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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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, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: GAN B'NAI SHALOM AT CONGREGATION B'NAI SHALOM	FACILITY NUMBER: 073408229
	VISIT DATE: 08/04/2022

NARRATIVE

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Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

LPA noted that infant teacher CHERRY LOU NAZAL was not associated to infant license. She has eligible clearance and active associations to other childcare facilities and has been working here since July 2022. LPA transferred and associated her during inspection. Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Director and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee [facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

In the areas that were evaluated, regulatory violation was observed. Citation were issued on 809D. Exit interview conducted and report was reviewed with the Director, (include name). A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 08/04/2022 02:23 PM - It Cannot Be Edited

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, 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: 08/04/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101170(e)(2)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above. rights risk to persons in care.Infant teacher CHERRY LOU NAZAL was not associated to infant license. She has eligible clearance and active associations to other childcare facilities and has been working here since July 18, 2022. This poses a potential risk to children.
	POC Due Date: 08/04/2022
	Plan of Correction
1 2 3 4	Since staff has eligible clearances, did not require exemption, LPA verified staff's information, transferred clearance and associated her to this license during inspection. This deficiency was cleared and Letter of Clearance provided. Director agreed to follow protocols and processes of associations moving forward.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Monica Mathur	TELEPHONE: (510) 622-2602
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022

LIC809 (FAS) - (06/04)

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