<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073405006
Report Date: 10/11/2023
Date Signed: 10/11/2023 02:17:06 PM

Document Has Been Signed on 10/11/2023 02:17 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 - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Marla MedwinTIME COMPLETED:
04:00 PM
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 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 todays inspection is to follow up on an incident self reported by the facility. On 9/15/23 facility reported a snake sighting inside the premises.

During today's inspection Marla stated a snake removal service was called, they inspected the grounds, walked around, checked behind sheds, small spaces and potential hiding areas. They did not find any nests or eggs and believe recent multiple sightings were random. A snake repellant product was recommended and facility custodians have been spraying the grounds with it. Professional service did not find any rats/other food source inside the premises. Parent volunteers have been removing weeds, tall grass, junk and items from the areas.

This incident requires no further action. Facility has been taking all necessary steps and implemented plans to keep premises safe for persons and children in care.

No deficiency was cited. 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)
Page: 1 of 1