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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 085400291
Report Date: 05/17/2019
Date Signed: 05/17/2019 02:26:13 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:FOURSQUARE CHRISTIAN EARLY LEARNING CENTERFACILITY NUMBER:
085400291
ADMINISTRATOR:KATHERINE (COLLY) KLEINFACILITY TYPE:
850
ADDRESS:144 BUTTE ST.TELEPHONE:
(707) 464-9501
CITY:CRESCENT CITYSTATE: CAZIP CODE:
95531
CAPACITY:84CENSUS: 0DATE:
05/17/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Katherine (Colly) KleinTIME COMPLETED:
02:45 PM
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A Licensee initiated case management inspection was conducted at the facility by Licensing Program Analyst (LPA) Kiriko Lynch for a decrease in capacity, application received by the Department on 05/01/19. The Licensee is requesting a decrease in capacity from 84 to 39 preschool children. The facility will only utilize back classroom #12 and front classroom #13 in the Main Building, and no longer utilize the two additional classrooms in the Education Building. The front and back classrooms to be utilized by staff and children measure for a total of 1,512.50 square feet which will accommodate the Licensee's capacity request. A previous fire clearance is maintained on file for the facility. There are an adequate number of restroom fixtures to meet the capacity decrease requirements. There have been no other changes to the previous interior activities and facilities plan or exterior playgrounds plan. During today's visit, LPA met with the Director, and the facility was toured and inspected. The facility was closed for the day at the time of inspection.

Today, on 05/17/19, the capacity decrease is approved for 39 preschool children.

This report was reviewed and discussed with the Director. All Licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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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