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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006901
Report Date: 06/16/2023
Date Signed: 06/16/2023 02:07:22 PM

Document Has Been Signed on 06/16/2023 02:07 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:4CS WILLOW CREEK STATE PRESCHOOLFACILITY NUMBER:
493006901
ADMINISTRATOR:SCHAEFER, PAULAFACILITY TYPE:
850
ADDRESS:2536 MARLOW ROADTELEPHONE:
(707) 570-2607
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
06/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Paula SchaeferTIME COMPLETED:
02:15 PM
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Licensing Program Analyst Glenn Ouye met with Paula Schaefer regarding a capacity increase for this child care program. The approved fire inspection was received by the department on June 15, 2023 for 32 preschoolers.

The application for the capacity increase was May 2, 2023. The facility is seeking to increase the capacity from 24 to 32 children. The facility has three sinks and three toilets. There is also sufficient indoor and outdoor square footage to support 32 preschoolers.

The capacity increase is approved effective today, June 16, 2023.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2023
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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