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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 480110179
Report Date: 03/05/2025
Date Signed: 03/05/2025 03:34:06 PM

Document Has Been Signed on 03/05/2025 03:34 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
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:BENICIA STATE PRESCHOOLFACILITY NUMBER:
480110179
ADMINISTRATOR/
DIRECTOR:		DUDLEY, ERICAFACILITY TYPE:
850
ADDRESS:2015 EAST 3RD ST.TELEPHONE:
(707) 747-8367
CITY:BENICIASTATE: CAZIP CODE:
94510
CAPACITY: 22TOTAL ENROLLED CHILDREN: 22CENSUS: 0DATE:
03/05/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:01 PM
MET WITH:Erica DudleyTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Selena Mariani and Glenn Ouye conducted a consultative case management visit to discuss future room change from room 26 & 27 to room 12 and 13 with Center Director (CD) Erica Dudley. Room 12 and 13 measured 1655.88 square feet for indoor activity space which currently has two sinks. There will need to be three toilets and three sinks to care for 42 children. Outdoor space was not measured today. This square footage accommodate 42 children in care.

Report was reviewed and provided to Center Director, Erica Dudley.
Notice of site visit was provided.
Leslie LeporiTELEPHONE: (707) 588-5060
Selena MarianiTELEPHONE: (916) 605-8974
DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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