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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073405006
Report Date: 09/16/2025
Date Signed: 09/16/2025 11:44:32 AM

Unsubstantiated


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, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/08/2025 and conducted by Evaluator Morgan Pringle
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20250908114313
FACILITY NAME:GAN B'NAI SHALOM AT CONGREGATION B'NAI SHALOMFACILITY NUMBER:
073405006
ADMINISTRATOR:MEDWIN, MARLAFACILITY TYPE:
850
ADDRESS:74 ECKLEY LANETELEPHONE:
(925) 933-7633
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY:65CENSUS: 5DATE:
09/16/2025
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Raquel AcostaTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Facility did not report a Director change
INVESTIGATION FINDINGS:
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On 9/16/2025 at 8:55am Licensing Program Analyst (LPA) Morgan Pringle met with Director Raquel Acosta for a 10-day complaint visit for a complaint that was received alleging facility did not report a Director change. Present during LPAs visit were six (6) preschool age children and two (2) additional staff members. One (1) classroom, room two (2) was toured. The facility operates from 7:00am - 6:00pm, Monday - Friday.

The facility is currently going through a change of ownership with Gan Aviv by Kid Time. Through interview it was found that the facility did not formally inform the Department of a qualified Director change within the required 10 days. Although the department staff was notified of internm directors in the past it was well after the required 10 days.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
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 2
Control Number 02-CC-20250908114313
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, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: GAN B'NAI SHALOM AT CONGREGATION B'NAI SHALOM
FACILITY NUMBER: 073405006
VISIT DATE: 09/16/2025
NARRATIVE
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LPA determined although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director Raquel Acosta.
SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Morgan Pringle
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2