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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490109272
Report Date: 07/19/2023
Date Signed: 07/19/2023 10:19:47 AM

Document Has Been Signed on 07/19/2023 10:19 AM - 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:4CS PETALUMA CHILD DEVELOPMENT CENTERFACILITY NUMBER:
490109272
ADMINISTRATOR:DUSEK, LINDAFACILITY TYPE:
850
ADDRESS:401 S MC DOWELLTELEPHONE:
(707) 763-4990
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 0DATE:
07/19/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jennyh CopelandTIME COMPLETED:
10:30 AM
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Licensing Program Analyst Glenn Ouye met with Jenny Copeland at the site to inspection the building prior to reopening. The facility classroom was completely remodeled and there are two connected classroom where there was previously only one class. The facility capacity was determined to be a maximum of 52 children. LPA Ouye and Ms. Copeland discussed that a capacity reduction from 54 to 52 children would be necessary.

The interior square footage supports sufficient square footage for 52 children. The outdoor square footage has almost twice the required square footage.
There are four toilets and six sinks for the children.

The building also has off limit areas that include a kitchen, office space, laundry area, staff restroom and storage rooms.

There is a fire extinguisher rated at 3A40BC and smoke/carbon monoxide detectors throughout the facility. Fire pull stations are located at every exit of the building.

The furniture, equipment and toys will be delivered and installed on July 24, 2023. LPA Ouye and or LPA Maciel will return for the final inspection.

LPA Ouye will take the facility off inactive status.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2023
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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