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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
480105679
Report Date:
02/16/2024
Date Signed:
02/16/2024 02:35:22 PM
Document Has Been Signed on
02/16/2024 02:35 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:
VUSD-CDC-FEDERAL TERRACE P/S
FACILITY NUMBER:
480105679
ADMINISTRATOR:
MONIQUE GARCIA
FACILITY TYPE:
850
ADDRESS:
415 DANIEL AVENUE
TELEPHONE:
(707) 556-8755
CITY:
VALLEJO
STATE:
CA
ZIP CODE:
94590
CAPACITY:
30
CENSUS:
DATE:
02/16/2024
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:00 PM
MET WITH:
Cecilia Patino
TIME COMPLETED:
02:45 PM
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LPA Ouye arrived at the VCUSD office to conduct a staff file review for VUSD-CDC-Federal Terrace Preschool.
SUPERVISOR'S NAME:
Leslie Lepori
TELEPHONE:
(707) 588-5060
LICENSING EVALUATOR NAME:
Glenn Ouye
TELEPHONE:
(707) 588-5042
LICENSING EVALUATOR SIGNATURE:
DATE:
02/16/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/16/2024
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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