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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010030
Report Date: 07/14/2021
Date Signed: 07/14/2021 01:56:20 PM

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:MILA'S PRESCHOOL AND CHILDCARE CENTER-INFANTFACILITY NUMBER:
173010030
ADMINISTRATOR:KRYSTAL GOMEZFACILITY TYPE:
830
ADDRESS:21036 WASHINGTON STREETTELEPHONE:
(707) 968-5005
CITY:MIDDLETOWNSTATE: CAZIP CODE:
95461
CAPACITY:12CENSUS: DATE:
07/14/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Mila Zavaleta, Krystal Gomez and Sharlene GomezTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with the licensees to conduct a prelicensing inspection.

The application was received by the department on January 20, 2021. The fire inspection was approved by Lake County Building Division on July 6, 2021.

LPA inspected the interior and exterior of the preschool facility. The program will operate from Monday through Friday, 7:30am to 5:30pm.

There is a changing table within arms reach a sink. There are age appropriate furniture, toys and equipment. A small refrigerator is used to store breast milk and formula for the infants.

Currently children will bring their own lunch and snacks. Cribs and cots are available for the children during nap time.

LPA conducted a facility inspection including capacity determination on a prior visit.

The outdoor area has sufficient area and fall protection. There is also sufficient shade. The children will bring personal water bottles that can be refilled during as needed to reduce Covid-19 transmission. The licensee discussed Covid-19 mitigation protocols. Hygiene, daily wellness checks and sanitation/cleaning were discussed.

The sign in/out procedures were discussed.

The facility is approved for licensure for 8 infants children ages birth through two years old effective July 14, 2021.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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