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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010074
Report Date: 09/26/2022
Date Signed: 09/26/2022 11:40:23 AM

Document Has Been Signed on 09/26/2022 11:40 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:PETALUMA VILLAGE PRESCHOOL EASTFACILITY NUMBER:
493010074
ADMINISTRATOR:SCHMIDT, CASEYFACILITY TYPE:
850
ADDRESS:400 ELY ROADTELEPHONE:
(707) 364-4979
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: 29TOTAL ENROLLED CHILDREN: 29CENSUS: 0DATE:
09/26/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Casey SchmidtTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with applicant Casey Schmidt to conduct the prelicensing inspection. The initial application was received by the department on May 26, 2021. The applicant brought in a modular commercial building to use as the child care center instead of using a modular home.

The building has 6 rooms one of which is a large main classroom. There are two bathrooms. There are a total of 4 sinks and 2 toilets for the children. There is sufficient square footage to support 30 preschool children. There are functional smoke and carbon monoxide detectors. There is a fire extinguisher rated at 2A10BC which is mounted near the entry door. There is functional heating and cooling for the building. There is sufficient equipment, furniture, toys and sleeping cots for the children. The facility will use Brightwheel sign in & sign out program. The sign in and sign out requirements were discussed with the applicant.

The outdoor activity area also has sufficient square footage to support the 30 children. There is sufficient outdoor equipment and toys for the children. The entire outdoor area surface has wood chip cushioning. There are shade sails to provide shade for the children. Outdoor hydration for the children will be achieved with individual water bottles.

The applicant was reminded that all adults 18 years and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PETALUMA VILLAGE PRESCHOOL EAST
FACILITY NUMBER: 493010074
VISIT DATE: 09/26/2022
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LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

The applicant indicated that an approved fire clearance is pending the final permit approval. Upon receipt of the approved fire clearance, the facility will be approved for licensure.

Exit interview conducted and report was reviewed with the applicant, Casey Schmidt.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC809 (FAS) - (06/04)
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