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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010105
Report Date: 09/15/2021
Date Signed: 09/15/2021 02:29:16 PM

Document Has Been Signed on 09/15/2021 02:29 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:MIXED GREENS SHALOM PRESCHOOLFACILITY NUMBER:
493010105
ADMINISTRATOR:HEATHER BLACK/JESSICA CROSFACILITY TYPE:
850
ADDRESS:85 LA PLAZATELEPHONE:
(707) 225-8753
CITY:COTATISTATE: CAZIP CODE:
94931
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/15/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Heather Ashton BlackTIME COMPLETED:
02:45 PM
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Licensing Program Analysts (LPA) Yang Yang and Glenn Ouye met with applicant to conduct a prelicensing inspection of the facility. The interior and exterior of the facility was inspected and measured to confirm capacity. The application for MIxed Greens Shalom Preschool was received by the department on July 15, 2021. The applicant is seeking licensure for 24 preschool age children.

The facility interior has two classrooms. Children's restrooms are located outside of the classrooms. The interior square footage supports 21 children. The outdoor activity area support over the requested square footage requirement. A capacity determination worksheet will be included with the file. There are smoke and carbon monoxide detectors as well as fire extinguishers rated at 2A10BC. There are four toilets and three urinals and four sinks for the preschool children. There is a separate staff restroom.
The sign in and sign out is done at the main entrance just outside of the front door. The applicant is aware of the sign in and sign out requirements and will be using Procare program for the process. Covid-19 wellness checks are also done in conjunction with the daily sign in.

There is sufficient furniture, equipment and toys for the children. There is also sufficient sleeping mats for the children during nap time.

The outdoor area has multiple areas with adequate shade. There is sufficient sand used as fall protection for the play structure. The Director will ensure that the sand will be fluffed if the sand is compressed. The children will use personalized water bottles or cups for hydration.

LPA Ouye and Yang discussed Covid-19 mitigation plans. The facility will conduct daily wellness screening including health questions during sign-in/drop off. The children will be wearing masks at all times except during eating, drinking and napping. The program intends to be outdoors over 95 percent of the time during Covid-19. The staff will do continuous cleaning and sanitizing throughout the day to reduce the transmission of Covid-19.

The facility is approved for licensure effective September 15, 2021.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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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