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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073401949
Report Date: 02/28/2023
Date Signed: 02/28/2023 01:13:43 PM

Document Has Been Signed on 02/28/2023 01:13 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 ILAN PRESCHOOL - TEMPLE ISAIAHFACILITY NUMBER:
073401949
ADMINISTRATOR:COURTNEY LUDLOWFACILITY TYPE:
850
ADDRESS:945 RISA ROADTELEPHONE:
(925) 284-8453
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY: 95TOTAL ENROLLED CHILDREN: 95CENSUS: 75DATE:
02/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Courtney LudlowTIME COMPLETED:
01:30 PM
NARRATIVE
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On 02/28/2023. Licensing Program Analyst (LPA) Ashley Curry conducted an unannounced Case Management inspection at Gan Ilan Preschool- Temple Isaiah. LPA met with director Courtney Ludlow and explained the purpose of today's visit. The facility self reported an unusual incident where a staff member violated a child's personal rights by grabbing a child as a form of punishment. LPA toured the facility, made observations, and conducted interviews. During the course of interviews it was determined the incident did occur, but the child was not hurt. Type B deficiency is being cited for a violation of a child's Personal Rights.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted, appeal rights were given, and report was reviewed with director Courtney Ludlow..

SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Ashley Curry
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2023
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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Document Has Been Signed on 02/28/2023 01:13 PM - It Cannot Be Edited


Created By: Ashley Curry On 02/28/2023 at 12:53 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 ILAN PRESCHOOL - TEMPLE ISAIAH
FACILITY NUMBER: 073401949

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2023
Section Cited
CCR
101223(a)(1)(3)

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101223 Personal Rights(a) The licensee shall ensure that each child is accorded the following personal rights:(1) To be accorded dignity in his/her personal relationships with staff and other persons. (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation...
This Requirement was not met as evidence by:
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By 03/28/2023 the director will submit proof of completion of a personal rights training for all staff.
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A staff member violated a child's personal rights by squeezing a child as a form of punishment. Although the child was not hurt this poses a potential risk to the health, safety, and personal rights of children in care.
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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:Loretta Dyson
LICENSING EVALUATOR NAME:Ashley Curry
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023


LIC809 (FAS) - (06/04)
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