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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405006
Report Date: 08/28/2024
Date Signed: 08/28/2024 04:22:29 PM

Document Has Been Signed on 08/28/2024 04:22 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GAN B'NAI SHALOM AT CONGREGATION B'NAI SHALOMFACILITY NUMBER:
073405006
ADMINISTRATOR/
DIRECTOR:		MEDWIN, MARLAFACILITY TYPE:
850
ADDRESS:74 ECKLEY LANETELEPHONE:
(925) 933-7633
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY: 65TOTAL ENROLLED CHILDREN: 65CENSUS: 23DATE:
08/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:STEPHANIE MACHADOTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On August 28, 2024 Licensing Program Analyst (LPA) Tasha Alexander met with interim director and consultant Leah Rosenthal-Kamik to discuss the findings to a previous complaint.

During today's visit it was discovered that several staff files are incomplete.

Please see the attached 809-d for citation

An exit interview was conducted with Leah Rosenthal-Kambik
SUPERVISORS NAME: Monica Mathur
LICENSING EVALUATOR NAME: Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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
Document Has Been Signed on 08/28/2024 04:22 PM - It Cannot Be Edited


Created By: Tasha Hackett-Alexander On 08/28/2024 at 03:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: GAN B'NAI SHALOM AT CONGREGATION B'NAI SHALOM
FACILITY NUMBER: 073405006

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2024
Section Cited
CCR
101217

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101217 Personnel Records
a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:
(11) A health screening as specified in Section 101216(g).
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Licensee will have each staff member obtain a health screening, TB test and immunizations from their doctor and submit a copies to community care licensing by 9/11/24
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TTHIS REQUIREMENT WAS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS: which revealed 6 staff members do not have health screenings, TB test results and immunization records in file
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Type B
09/11/2024
Section Cited
HSC1596.8662

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1596.8662 Availability of information regarding detecting and reporting child abuse and neglect; training for mandated reporter who is licensed day care provider, administrator, or employee of a licensed child day care facility; proof of completion

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Licensee will have each staff member renew or complete the mandated reporter training and submit a copy of the updated certificate to community care licensing by 9/11/24
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(3) On and after January 1, 2018, a person who becomes an administrator or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a) within the first 90 days that he or she is employed at the facility and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.
THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY A REVIEW OF RECORDS WHICH REVEALED STAFF MEMBERS MANDATED REPORTER CERTIFICATES HAVE EXPIRED.
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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:Monica Mathur
LICENSING EVALUATOR NAME:Tasha Hackett-Alexander
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024


LIC809 (FAS) - (06/04)
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