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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073403896
Report Date: 10/30/2020
Date Signed: 11/06/2020 03:18:33 PM

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:MICHAEL LANE PRESCHOOLFACILITY NUMBER:
073403896
ADMINISTRATOR:OLSON, KIMFACILITY TYPE:
850
ADDRESS:682 MICHAEL LANETELEPHONE:
(925) 284-7244
CITY:LAFAYETTESTATE: CAZIP CODE:
94549
CAPACITY:17CENSUS: 0DATE:
10/30/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:20 AM
MET WITH:Holly HigginsTIME COMPLETED:
01:35 PM
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On 10/30/20 at 1:20pm, Licensing Program Analyst (LPA) Loretta Dyson conducted a case management tele-inspection thru the FaceTime application. A tele-inspection was done due to the COVID-19 pandemic. LPA met with Holly Higgins. LPA did not observe any children present. The facility has submitted a request for a temporary waiver to use the church's Parish Hall as an extension of the outdoor space, when weather or other outdoor conditions do not permit children to be outdoors. The facility operates on the grounds of St. Anselm's Episcopal Church.

A tour of the Parish Hall was completed with Ms. Higgins pointing the camera around the room. LPA observed that the room has sufficient lighting and appears to be clean and free of defects or dangerous conditions. LPA observed that the hall is carpeted and has enough space for gross motor play or other activities. The hall is a short distance from the preschool classroom.

LPA reminded Ms. Higgins that the waiver needs to be approved prior to using the hall. An electronic signature will not be obtained from the licensee, but the report will be mailed to the licensee for signature.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 873-6408
LICENSING EVALUATOR NAME: Loretta DysonTELEPHONE: (510) 622-2633
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020
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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