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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010488
Report Date: 08/02/2023
Date Signed: 08/02/2023 11:31:59 AM

Document Has Been Signed on 08/02/2023 11:31 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:KONOCTI USD CHILD DEVELOPMENT CENTER-P/SFACILITY NUMBER:
173010488
ADMINISTRATOR:ANGEL COPPAFACILITY TYPE:
850
ADDRESS:4750 GOLF AVENUETELEPHONE:
(707) 994-6475
CITY:CLEARLAKESTATE: CAZIP CODE:
95422
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: 0DATE:
08/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Angel CoppaTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPA) Glenn Ouye and Sebastian Phouthavong met the Director, Angel Coppa for a change of location from their prior location at 9345 Winchester Street, Lower Lake to this location. This program will also be increasing their capacity from 10 children to 24 children. The application was received by the department on July 17, 2023.

The location is a combination center that will serve infants and preschool age children. The preschool program has two classrooms. The bathroom is connected to both rooms. There are two toilets and two sinks for the children.
There are functioning smoke, carbon monoxide detectors and fire extinguishers.
There is sufficient equipment, furniture and toys for the program. There are sufficient sleeping mats for the children in care.

The outdoor activity area for the preschool program is not completed at this point. The estimated completion will be in October 2023. The facility will use a rotational waiver with the infant program until the outdoor area is completed.

The fire inspector is expected to return to do the final on August 4, 2023. Upon receipt of the approved fire clearance the facility will be approved for licensure.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2023
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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