<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
483010482
Report Date:
08/25/2023
Date Signed:
08/25/2023 02:20:58 PM
Document Has Been Signed on
08/25/2023 02:20 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 AGE
FACILITY NUMBER:
483010482
ADMINISTRATOR:
MORRIS, SAM
FACILITY TYPE:
840
ADDRESS:
2100 PENNSYLVANIA AVENUE
TELEPHONE:
(707) 720-5278
CITY:
FAIRFIELD
STATE:
CA
ZIP CODE:
94533
CAPACITY:
39
TOTAL ENROLLED CHILDREN:
39
CENSUS:
DATE:
08/25/2023
TYPE OF VISIT:
Prelicensing
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
Kim Wright
TIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Glenn Ouye reinspected the school age program location. The indoor room has been restored and is ready for use. There is sufficient furniture for the school age children to use. The outdoor area is also completed and ready for immediate use.
LPA is waiting for the licensee background clearance to be processed. The facility will be approved for licensure when the background clearance is approved.
SUPERVISORS NAME
:
Leslie Lepori
LICENSING EVALUATOR NAME
:
Glenn Ouye
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/25/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1