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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600768
Report Date: 06/19/2023
Date Signed: 06/19/2023 05:22:46 PM


Document Has Been Signed on 06/19/2023 05:22 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:CONGREGATION BETH ISRAEL/SID RUBIN PRESCHOOLFACILITY NUMBER:
376600768
ADMINISTRATOR:CATHY GOLDBERGFACILITY TYPE:
850
ADDRESS:9001 TOWNE CENTRE DRIVETELEPHONE:
(858) 900-2530
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY:105CENSUS: 46DATE:
06/19/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:10 PM
MET WITH:Director Cathy GoldbergTIME COMPLETED:
04:30 PM
NARRATIVE
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On 6/19/23 @ 4:10 p.m., Licensing Program Analyst (LPA) Joelle Redding, made an unannounced visit for the infant program. During the visit, LPA spoke with Director Cathy Goldberg and learned that Staff #1 had been working at the facility, in the preschool program, without a completed fingerprint clearance.

Type A deficiency is being cited on the attached LIC 809D. A civil penalty of $500 will be assessed on the attached form 421BG.

LPA, Joelle Redding, informed Director Cathy Goldberg, that this report dated 6/19/23, documents a Type A citation which shall be posted for 30 consecutive days as there is immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA, Joelle Redding, informed the Director Cathy Goldberg, to provide a copy of this licensing report dated 6/19/23, that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. LIC 9224 was provided for Director today.

NOTICE OF SITE VISIT WAS GIVEN AND WILL REMAIN POSTED FOR 30 DAYS. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2023
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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Document Has Been Signed on 06/19/2023 05:22 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: CONGREGATION BETH ISRAEL/SID RUBIN PRESCHOOL
FACILITY NUMBER: 376600768

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/20/2023
Section Cited
CCR
101170(e)(1)

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Criminal Record Clearance. All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department .
This requirement was not met as evidenced by:
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Director states that she during the chaos of Covid, she forgot to follow up on the clearance process and was just recently reminded of it. She immediately placed Staff #1 on leave pending the completion of the clearance. She will ensure that the clearance is complete prior to Staff #1's return.
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Based on interview with Director, Staff #1 was hired and allowed to work before the background clearance was completed. This is an immediate risk to the health and safety of children in care.
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She will ensure all future hires have a completed clearance prior to hire.

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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: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2023
LIC809 (FAS) - (06/04)
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