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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233010475
Report Date: 08/17/2023
Date Signed: 08/17/2023 02:06:30 PM

Document Has Been Signed on 08/17/2023 02:06 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:FORAGER SCHOOL, THEFACILITY NUMBER:
233010475
ADMINISTRATOR:WILDER, APARNAFACILITY TYPE:
850
ADDRESS:39145 SOUTH HIGHWAY 1TELEPHONE:
(707) 202-5013
CITY:GUALALASTATE: CAZIP CODE:
95445
CAPACITY: 16TOTAL ENROLLED CHILDREN: 16CENSUS: DATE:
08/17/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Aparna Wilder and Adela Martinez BergTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Aparna Wilder and Adela Martinez Berg to conduct the facility's prelicensing visit. The application for the center was received on July 5, 2023. The approved fire clearance was received on August 3, 2023.

The center has a large great room and a smaller dramatic play room. There is a staff room/storage room which is off limits and the kitchen which is also off limits. There are doors with latches and a child safety gate to make these areas inaccessible. There is a bathroom with a toilet and sink. The facility will be installing a second sink in the classroom and a second toilet in the bathroom in the future. The first aid kit is stored in the staff/storage room. There are smoke/carbon monoxide detectors and two fire extinguishers rated at least 2A10BC. There are two outdoor activity areas which are fully fenced. One activity area is in front of the building and the other is behind the building. The facility has ground based activity equipment for the children. There is sufficient shade for the children.

Applicant was reminded that all adults 18 and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2023
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: FORAGER SCHOOL, THE
FACILITY NUMBER: 233010475
VISIT DATE: 08/17/2023
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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with the applicant and director the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

Applicant, was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (NCO and 4C's) throughout California.

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 platforms. 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.

A notice of site visit will be given to the facility staff for all visits excluding the prelicensing visit and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

The license for 15 preschool children is approved effective August 17, 2023.

Exit interview conducted and report was reviewed with the applicant, Aparna Wilder.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC809 (FAS) - (06/04)
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