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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
073401949
Report Date:
06/15/2022
Date Signed:
06/15/2022 12:07:41 PM
Document Has Been Signed on
06/15/2022 12:07 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:
COURTNEY LUDLOW
FACILITY TYPE:
850
ADDRESS:
945 RISA ROAD
TELEPHONE:
(925) 284-8453
CITY:
LAFAYETTE
STATE:
CA
ZIP CODE:
94549
CAPACITY:
95
CENSUS:
DATE:
06/15/2022
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Courtney Ludlow
TIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Diana Campos arrived at facility and met with center Director Courtney Ludlow for the purpose of conducting a Case Management inspection regarding a self reported incident on 2/3/2022.
Staff and children Interviews were conducted. Due to insufficient information available at this time further investigation will be required.
No deficiencies cited as a result of todays inspection.
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:
04/06/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/06/2022
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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