CONGREGATION BETH ISRAEL-GAN SHALOM

Type A citation from complaint investigation - immediate risk

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analysts Cherie Acosta and Sikia Blue conducted an unannounced case management visit. LPAs met with Director Emma Schnur. Director self reported an incident that occurred on 7/14/23. It was reported that there were 13 children, 1 teacher and 1 teacher aide on the play yard. The teacher aide stepped into the classroom to get something form the classroom which left the teacher out of ratio. It was reported the teacher was out of ratio for approximately 5 seconds. See 809-D for deficiencies cited during today's visit. The facility was previously cited for being out of ratio on 4/25/23. A civil penalty of $250.00 is assessed today. Notice of Site Visit was provided and must be posted for 30 day. Exit interview and report reviewed with Emma Schnur SUPERVISORS NAME: Sherelle Johnson LICENSING EVALUATOR NAME: Cherie Acosta LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023 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 2 FACILITY NAME: CONGREGATION BETH ISRAEL-GAN SHALOM FACILITY NUMBER: 010210478 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 08/16/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 08/21/2023 Section Cited CCR 101216.3(a) 1 2 3 4 5 6 7Teacher-Child Ratio. There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.1 2 3 4 5 6 7Director shall provide proof of staff training on ratio. Director shall submit the training agenda and proof of staff attendance to CCL by 8/21/23. 8 9 10 11 12 13 14This requirement was not met as eviendced by: a teacher was supervising 13 children alone when the aide stepped into the classroom which poses a potential risk to the health and safety of children in care.8 9 10 11 12 13 14• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Sherelle Johnson LICENSING EVALUATOR NAME:Cherie Acosta LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25Licensing Program Analysts Cherie Acosta and Sikia Blue conducted an unannounced case management visit. LPAs met with Director Emma Schnur. Director self reported an incident that occurred on 7/14/23. It was reported that there were 13 children, 1 teacher and 1 teacher aide on the play yard. The teacher aide stepped into the classroom to get something form the classroom which left the teacher out of ratio. It was reported the teacher was out of ratio for approximately 5 seconds. See 809-D for deficiencies cited during today's visit. The facility was previously cited for being out of ratio on 4/25/23. A civil penalty of $250.00 is assessed today. Notice of Site Visit was provided and must be posted for 30 day. Exit interview and report reviewed with Emma Schnur SUPERVISORS NAME: Sherelle Johnson LICENSING EVALUATOR NAME: Cherie Acosta LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023 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 2 FACILITY NAME: CONGREGATION BETH ISRAEL-GAN SHALOM FACILITY NUMBER: 010210478 DEFICIENCY INFORMATION FOR THIS PAGE: VISIT DATE: 08/16/2023 Deficiency Type POC Due Date / Section NumberDEFICIENCIESPLAN OF CORRECTIONS(POCs) Type B 08/21/2023 Section Cited CCR 101216.3(a) 1 2 3 4 5 6 7Teacher-Child Ratio. There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.1 2 3 4 5 6 7Director shall provide proof of staff training on ratio. Director shall submit the training agenda and proof of staff attendance to CCL by 8/21/23. 8 9 10 11 12 13 14This requirement was not met as eviendced by: a teacher was supervising 13 children alone when the aide stepped into the classroom which poses a potential risk to the health and safety of children in care.8 9 10 11 12 13 14• Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected. 1 2 3 4 5 6 71 2 3 4 5 6 7 1 2 3 4 5 6 71 2 3 4 5 6 7 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:Sherelle Johnson LICENSING EVALUATOR NAME:Cherie Acosta LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023

Type B citation - potential risk if not corrected

Type A citation from complaint investigation - immediate risk

Type A citation from complaint investigation - immediate risk