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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490109162
Report Date: 09/25/2020
Date Signed: 09/25/2020 02:54:05 PM

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:OLD ADOBE SCHOOLFACILITY NUMBER:
490109162
ADMINISTRATOR:MURRAY, MICHAELAFACILITY TYPE:
850
ADDRESS:252 WEST SPAIN STREETTELEPHONE:
(707) 408-2383
CITY:SONOMASTATE: CAZIP CODE:
95476
CAPACITY:30CENSUS: 20DATE:
09/25/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Michaela Murray, DirectorTIME COMPLETED:
03:00 PM
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LPA Kevin O'Connell conducted a tele-visit case management visit to add classroom #3 for extra use. This room is located next to the church office and adjacent to the building with classroom #1.
LPA and the Director toured the grounds and room. There will be a check in table just outside the classroom door. This room will be used for 10 children in the four to five age range. The facility has written permission from the church to use the space. There is adequate space inside and outside as this is not an increase in capacity but adding additional room to increase the space.
Fire Marshall approval was given 8/4/2020. There is a working carbon monoxide detector and a charged fire extinguisher in the room. Play tables will be spaced out in the room. There is one bathroom and sink inside the classroom.
Approval is given to use the space.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2020
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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