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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 230110065
Report Date: 09/27/2024
Date Signed: 09/27/2024 10:57:08 AM


Document Has Been Signed on 09/27/2024 10:57 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:SOUTH COAST DAY CARE-SCHOOL AGEFACILITY NUMBER:
230110065
ADMINISTRATOR:VAUGHAN, TERRI A.FACILITY TYPE:
840
ADDRESS:115 LAKE STREETTELEPHONE:
(707) 882-2946
CITY:POINT ARENASTATE: CAZIP CODE:
95468
CAPACITY:15CENSUS: 0DATE:
09/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Kevin PolkTIME COMPLETED:
10:59 AM
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On 9/23/24, Licensing Program Analyst (LPA) Robert Maciel was emailed by the board secretary for South Coast Day Care, Kevin Polk, a board resolution stating the intent to close the facility. The facility has been on inactive status since 01/05/2023 due to the roof of the facility collapsing during a storm

Today, a visit was made to the facility by LPA Maciel to confirm closure

At 10:37 AM LPA Maciel arrived at the facility address to confirm that licensed child care is no longer being provided and met with facility representative Kevin Polk. LPA did not observe evidence that care was being provided. Kevin provided LPA Maciel with the facility license.

Effective, 09/27/24 facility #230110065 is no longer licensed and can no longer provide licensed care to children.

LPA Maciel will process the closure with the effective closure date of 09/27/24.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Robert MacielTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2024
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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