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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010074
Report Date: 11/02/2022
Date Signed: 11/02/2022 10:59:26 AM

Document Has Been Signed on 11/02/2022 10:59 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: 30CENSUS: 0DATE:
11/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Casey SchmidtTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA's) Glenn Ouye and Yang Yang met with Applicant/Director Casey Schmidt to conduct a final Prelicensing visit. An initial prelicensing visit was conducted on September 26, 2022.

The indoor and outdoor activity area was inspected. The indoor area consist of six rooms for the children. There are two sinks and two toilets for the children in care. There is a fire extinguisher rated at 2A10BC. There is a functioning carbon monoxide detector. The fire alarm which includes the smoke alarms is being installed currently. The local fire inspector will conduct the inspection after the fire alarm installation is competed.

The applicant will have 6 months from the date of licensure to complete the lead testing.

The outdoor area has no changes from the prior inspection. There are ground based equipment and toys for the children. There is adequate shade in the outdoor area.

Upon receipt of the approved fire clearance the center license will be approved for a capacity of 30 preschool children.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2022
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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