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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405006
Report Date: 10/11/2023
Date Signed: 10/11/2023 02:18:06 PM

Document Has Been Signed on 10/11/2023 02:18 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 SHALOMFACILITY NUMBER:
073405006
ADMINISTRATOR:MEDWIN, MARLAFACILITY TYPE:
850
ADDRESS:74 ECKLEY LANETELEPHONE:
(925) 933-7633
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY: 65TOTAL ENROLLED CHILDREN: 45CENSUS: 41DATE:
10/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Marla MedwinTIME COMPLETED:
03:00 PM
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On 10/11/23 Licensing Program Analysts (LPAs) Monica Mathur and Brindha Govindasamy conducted an unannounced Case Management inspection at Gan B'Nai Shalom at Congregation B'Nai Shalom and met with Director, Marla Medwin.

Purpose of today's inspection is to verify plan of corrections submitted by the facility as a result of citations issued on 8/17/23 with Type A and B deficiencies. It was verified that all families have received copy of Type A report and signed Statement Acknowledging Receipt of Licensing Reports LIC9224 are kept in children files. Facility submitted plan of corrections and steps taken to implement them.

Citations were cleared today and Letters of Clearance provided during today's inspection. No deficiencies were cited today. This report was reviewed with Director, Marla Medwin.
A NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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