<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233009652
Report Date: 12/19/2020
Date Signed: 12/22/2020 10:11:18 AM

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:POLLIWOG PLAYSCHOOLFACILITY NUMBER:
233009652
ADMINISTRATOR:RICCA, WANDAFACILITY TYPE:
850
ADDRESS:19201 DEL MAR DRIVETELEPHONE:
(707) 961-0874
CITY:FORT BRAGGSTATE: CAZIP CODE:
95437
CAPACITY:30CENSUS: 0DATE:
12/19/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Ms. RiccaTIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Glenn Ouye met with Dena Ricca to measure the interior and exterior square footage as she is applying for a capacity increase and to also discuss the process of her applying for a waiver to allow her to provide care to school age children under her preschool license to allow children to partake in distance learning because the locals schools are closed due to the Covid-19 pandemic. LPA provided her with the licensed center attestation form and asked her to return the form and the following to LPA Ouye (a copy of her first aid & CPR certificate, LIC610). Due to Covid-19 pandemic, LPA advised the licensee that LPA would take measurements and leave and follow up by sending a copy of the report to the licensee via email.

LPA measured the interior and exterior of the facility.

The interior has the following:

3 toilets (45 children)
4 sinks

Interior square footage was measured to be 1581 sq ft which allows for 45 children as the maximum capacity based on interior square footage.

The exterior square footage was measured at 11,112 sq ft.

LPA advised the licensee that the maximum capacity based on the capacity determination is 45 children.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1