073401949-3-9-2022-02-CC-DCAS-CCD3R4-20220309172806

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 073401949
Report Date: 03/09/2022
Date Signed: 03/09/2022 05:28:22 PM

Document Has Been Signed on 03/09/2022 05:28 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 ISAIAH		FACILITY NUMBER:	073401949
ADMINISTRATOR:	SORSCHER, ALISON		FACILITY TYPE:	850
ADDRESS:	945 RISA ROAD		TELEPHONE:	(925) 284-8453
CITY:	LAFAYETTE	STATE: CA	ZIP CODE:	94549
CAPACITY:	95	CENSUS: 47	DATE:	03/09/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Courtney Ludlow		TIME COMPLETED:	05:30 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	Licensing Program Analysts (LPA's) Cherie Acosta and Diana Campos arrived at the facility and met with center Director Courtney Ludlow for the purpose of conducting a Case Management inspection regarding three self reported incidents. One incident report states that on 11/18/2020 one staff and six children took the elevator. One child was upset and refused to leave the elevator with the rest of the group. Staff reached out to prevent door from closing but it briefly shut while child remained inside. Teacher pressed the elevator button and door opened. Entire incident was less than 30 seconds. Second incident report states that on 9/24/2021 a teacher took a child to use the bathroom. While child used the restroom, teacher stood in the doorway to the outdoor play space. The door between the classroom and outdoor closed and the child was in the bathroom inside the classroom without visual supervision for about one minute. A third incident report states that on 2/28/2022 During one classroom's transition from the garden into the classroom to use the bathroom, a teacher from a different classroom saw two children left in the garden area after all the rest of the children were inside. Staff noticed the children were laughing saying they hid from their teacher. Staff then notified the children's teacher via text that she had the children and brought them to the classroom. Teacher estimated children were without supervision for about one minute. See attached 809D for deficiency being cited today. A civil penalty of $500 is being assessed today for absence of supervision.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

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 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 ISAIAH	FACILITY NUMBER: 073401949
	VISIT DATE: 03/09/2022

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
26
27
28
29
30
31
32

LPA's informed center Director Courtney Ludlow that this report dated 3/09/2022 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA's informed the center Director to provide a copy of this licensing report dated 3/09/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted with Director Courtney Ludlow. Notice of Site Visit was provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Sherelle Johnson	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 03/09/2022 05:28 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 ISAIAH	FACILITY NUMBER: 073401949
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/09/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/10/2022 Section Cited	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	children were left unsupervised on at least 3 separate occasions. This poses an immediate 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 violation will result in a $1000 civil penalty.
	1 2 3 4 5 6 7
	1 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	TELEPHONE: (510) 622-2592
LICENSING EVALUATOR NAME: Diana Campos	TELEPHONE: (510) 873-6322
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2022

LIC809 (FAS) - (06/04)

Page: 3 of 3