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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010482
Report Date: 08/07/2023
Date Signed: 08/07/2023 04:56:30 PM

Document Has Been Signed on 08/07/2023 04:56 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:BAYNORTH LEARNING CENTER - SCHOOL AGEFACILITY NUMBER:
483010482
ADMINISTRATOR:MORRIS, SAMFACILITY TYPE:
840
ADDRESS:2100 PENNSYLVANIA AVENUETELEPHONE:
(707) 720-5278
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: DATE:
08/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Kim WrightTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Glenn Ouye conducted a capacity determination for this combination center. The center will operate an infant, preschool and school age program.

There is sufficient indoor and outdoor square footage to support the school age program.

The indoor school age area will require set up as there was prior water damage from a malfunctioning sprinkler. The outdoor area has sufficient shade. The facility will also use the gymnasium at times for the school age children..

Follow up on required forms that have been emailed to Kim Wright will also need to be submitted.

Upon receipt of the documents, approved fire clearance and indoor activity area set up completed the facility will be approved for licensure.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2023
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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