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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 230110064
Report Date: 01/23/2023
Date Signed: 01/23/2023 12:55:57 PM


Document Has Been Signed on 01/23/2023 12:55 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:SOUTH COAST DAY CAREFACILITY NUMBER:
230110064
ADMINISTRATOR:VAUGHAN, TERRI A.FACILITY TYPE:
850
ADDRESS:115 LAKE STREETTELEPHONE:
(707) 882-2946
CITY:POINT ARENASTATE: CAZIP CODE:
95468
CAPACITY:25CENSUS: 0DATE:
01/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kevin PolkTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Exe Director Kevin Polk to perform a capacity determination of a location at 40 School St. Point Arena where the facility will relocate while the exiting location at 115 Lake Street is closed due to storm damage. The location closed on January 5, 2023. The facility will go on inactive status while the building's needs are addressed. Mr. Polk indicated that they may try to have a portable classroom(s) brought in.

A change of location and capacity reduction application will be turned in as soon as possible. LPA Ouye will work with the Executive Director during the location change.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:
DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/23/2023
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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