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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233010356
Report Date: 02/02/2023
Date Signed: 02/02/2023 01:36:40 PM

Document Has Been Signed on 02/02/2023 01:36 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:SOUTH COAST DAY CAREFACILITY NUMBER:
233010356
ADMINISTRATOR:POLK, KEVIN YAGER, KRISTINFACILITY TYPE:
850
ADDRESS:40 SCHOOL STREETTELEPHONE:
(818) 219-7478
CITY:POINT ARENASTATE: CAZIP CODE:
95468
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: DATE:
02/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kristin YagerTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Director Kristin Yager to conduct the prelicensing inspection. The facility has moved to this location due to the winter storm damage.

The application was received by the department on 1/30/2023. The approved fire clearance was received on 2/2/2023.

The facility has two main areas for child care. There are functioning smoke/carbon monoxide detectors and a fully charged fire extinguisher rated at 3A40BC. There is sufficient furniture, toys and equipment for the children. There is sufficient square footage for the children in care. There are two toilets and two sinks for the children. There is a separate staff restroom in the church which is on the property.

The outdoor area is fully fenced and supports the capacity of the facility. The equipment is ground based activity with no climbing structures.

LPA reviewed with Director, Kristin Yager the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: SOUTH COAST DAY CARE
FACILITY NUMBER: 233010356
VISIT DATE: 02/02/2023
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SUBSCRIBE TO CCLD IMPORTANT INFORMATION

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform.
To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview conducted and report was reviewed with Director Kristin Yager.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC809 (FAS) - (06/04)
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