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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010678
Report Date: 07/25/2024
Date Signed: 07/25/2024 09:26:24 AM

Document Has Been Signed on 07/25/2024 09:26 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:VANSLAMBROUCK, LILIA FCCHFACILITY NUMBER:
493010678
ADMINISTRATOR/
DIRECTOR:		VANSLAMBROUCK, LILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 494-5724
CITY:GRATONSTATE: CAZIP CODE:
95444
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
07/25/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Lilia VanSlambrouckTIME VISIT/
INSPECTION COMPLETED:
09:35 AM
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A follow-up prelicensing visit was made to the facility by Licensing Program Analyst (LPA) Mindy Mohr to confirm that there is a fire extinguisher rated at least 2A10BC in the facility. Furthermore during the initial prelicensing inspection LPA was experiencing technical issues and was unable to obtain the applicants signature. During the initial prelicensing visit on 07/22/2024, the LPA observed that the applicant did not have a fire extinguisher rated at least 2A10BC.

During today's follow-up prelicensing inspection, the LPA observed that the applicant has a fire extinguisher rated at least 2A10BC and it is fully charged. LPA also obtained the applicants signature on the prelicensing report dated 07/22/2024.

This large FCCH license is approved effective today's date 07/25/2024.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Melinda Mohr
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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