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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490102569
Report Date: 10/01/2024
Date Signed: 10/01/2024 02:39:38 PM

Document Has Been Signed on 10/01/2024 02:39 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:GAN ISRAEL PRESCHOOLFACILITY NUMBER:
490102569
ADMINISTRATOR/
DIRECTOR:		TERI PORTERFACILITY TYPE:
850
ADDRESS:740 WESTERN AVENUETELEPHONE:
(707) 763-5136
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY: 35TOTAL ENROLLED CHILDREN: 27CENSUS: 19DATE:
10/01/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:03 PM
MET WITH:Teri PorterTIME VISIT/
INSPECTION COMPLETED:
02:48 PM
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Licensing Program Analyst (LPA) Robert Maciel made a Case Management visit for the purpose of reviewing plans to construct a shade structure in the outdoor play area and met with Director Teri Porter and facility board member Stuart Nissenbaum, who is responsible for overseeing the construction.

LPA reviewed the proposed location for the shade structure, which is to be built in the back side of the outdoor play area, next to the large play structure. The surface of the area is currently bark and will be replaced with concrete to support the construction. The structure itself will not have any walls, it is only supported by four beams, thus not reducing the available activity space in the backyard.

Director stated that construction is planned to begin on 10/7/24. LPA requested the Director submit an updated LIC999 Facility Sketch to record the new layout of the outdoor play area to the department before construction begins.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Robert Maciel
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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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