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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073401949
Report Date: 11/06/2024
Date Signed: 12/06/2024 03:29:46 PM

Document Has Been Signed on 12/06/2024 03:29 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
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:GAN ILAN PRESCHOOL - TEMPLE ISAIAHFACILITY NUMBER:
073401949
ADMINISTRATOR/
DIRECTOR:		COURTNEY LUDLOWFACILITY TYPE:
850
ADDRESS:945 RISA ROADTELEPHONE:
(925) 284-8453
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY: 95TOTAL ENROLLED CHILDREN: 95CENSUS: DATE:
11/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Courtney LudlowTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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*THIS IS AN AMENDED REPORT*

On 11/06/2024 at 9:15 AM Licensing Program Analyst (LPA), A. Curry conducted an unannounced visit to follow up on a self reported unusual incident. LPA met with the Director, Courtney Ludlow, to explain the purpose of today's visit. LPA toured the facility and conducted interviews. Based on information obtained, LPA determined that the facility is in compliance with California Code of Regulations, Title 22.

During today's inspection, there were no violations observed.

Exit interview conducted, appeal rights were given, and report was reviewed with the Director, Courtney Ludlow. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Christina Watts
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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 is an Amendment of Original Document on 12/03/2024 09:21 AM


Created By: Christina Watts On 11/06/2024 at 10:24 AM
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
OAKLAND CC RO, 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: 11/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed




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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:Sherelle Johnson
LICENSING EVALUATOR NAME:Christina Watts
LICENSING EVALUATOR SIGNATURE:
DATE: 11/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/06/2024


LIC809 (FAS) - (06/04)
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