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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010295
Report Date: 12/01/2022
Date Signed: 12/01/2022 09:17:25 AM

Document Has Been Signed on 12/01/2022 09:17 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:HOGELAND STUSSER, DONNA FCCHFACILITY NUMBER:
493010295
ADMINISTRATOR:HOGELAND STUSSER, DONNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 293-3400
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
12/01/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Donna Hogeland StusserTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with the applicant to inspect the pool fence. The five foot fence height completely surrounds the pool and jacuzzi area. There are two self closing gates. One of the gates is not closing and latching consistently. LPA has requested that the applicant make necessary adjustments to the latch/gate so the gate does close and latch every time the gate is closed. There are a some bush branches protruding through the fence on west side of the pool fence that will be required to be cut and maintained so potential climbing foot and hand holds are eliminated.

LPA also spoke with fire inspector Scott Garrett of the Goldridge Fire District. He indicated that he needs a copy of the fire safety inspection request before he can inspect the home. LPA Ouye will email a copy of the fire safety inspection request to him.

When the noted items are corrected and the fire inspection is approved, LPA will be able to approve the licensure.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2022
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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