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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480101919
Report Date: 09/13/2019
Date Signed: 09/13/2019 11:52:19 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:NORTH HILLS CHRISTIAN SCHOOLFACILITY NUMBER:
480101919
ADMINISTRATOR:LUDEZA PARINASFACILITY TYPE:
850
ADDRESS:200 ADMIRAL CALLAGHAN LANETELEPHONE:
(707) 644-5284
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:132CENSUS: 67DATE:
09/13/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH:Jennifer PortilloTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Melchisedeck Augustin made an unannounced follow up case management inspection, at the request of the facility to add classroom A-104 as an on limits area. The facility submitted to the Rohnert Park Local Unit Office, an updated facility sketch that reflects room A-104 is on limits. On 08/30/19, the Vallejo Fire Department conducted a Fire Safety Inspection and the facility was granted a fire clearance for the usage of the classroom. During today's inspection, LPA met with Assistant Director Jennifer Portillo; and LPA discussed the purpose of the inspection with the Assistant Director. LPA toured and measured the square footage of the space. The classroom has one sink that delivers cold water and one toilet. The classroom has a function smoke and carbon monoxide detectors; and a fire extinguisher rated at least 2A10BC. LPA observed all electrical wall outlets were covered with plastic covers and the classroom was free of hazards. Room A-104 is on limits effective 09/13/19. All licensing reports are public information and must be made available upon request for at least three years.

This report was reviewed and discussed with the Assistant Director. Notice of Site Visit shall be posted for 30 days from today's inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Melchisedeck AugustinTELEPHONE: (707) 494-4918
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
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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