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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490111042
Report Date: 11/17/2021
Date Signed: 11/17/2021 09:42:54 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:RAINBOW GARDEN AT KENWOOD SCHOOLFACILITY NUMBER:
490111042
ADMINISTRATOR:DAWSON, JILLFACILITY TYPE:
850
ADDRESS:230 RANDOLPH AVENUETELEPHONE:
(707) 833-6551
CITY:KENWOODSTATE: CAZIP CODE:
95452
CAPACITY:15CENSUS: 11DATE:
11/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jill Dawson, DirectorTIME COMPLETED:
09:55 AM
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LPA Kevin O'Connell made a case management to inspect a newly added piece of play equipment installed in the play yard. Months prior to installation, Director notified CCL of the proposed addition and recently provided pictures to LPA of the installed swing.
This Preschool sits on the edge of the Kenwood Elementary campus.
The tire swing has a dedicated expansive raised bed of wood chips underneath to absorb falls and has at least six feet of space around it.
This new "Tire Swing" was approved for use by the school's insurance carrier on 11/12/21.
There were no hazards observed in the play yard.
This swing is now approved for use.
No tittle 22 regulations were cited during today's inspection.
A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2021
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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