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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006190
Report Date: 05/11/2023
Date Signed: 05/11/2023 03:46:44 PM


Document Has Been Signed on 05/11/2023 03:46 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:4CS WINDSOR STATE PRESCHOOLFACILITY NUMBER:
493006190
ADMINISTRATOR:MICHELLE MARTINFACILITY TYPE:
850
ADDRESS:79 PLEASANT AVENUETELEPHONE:
(707) 836-7068
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:40CENSUS: 18DATE:
05/11/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Michelle MartinTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA's) Glenn Ouye and Sebastian Phouthavong arrived to conduct a capacity determination for TK classroom 7A which will be used temporarily while the preschool classroom floor is replaced.

The floor installation will start on the week of June 19th. The facility will vacate the preschool center classroom on June 16, 2023 and will use classroom 7A. The facility will use room classroom 7A until June 26 to June 28, 2023. The classroom is a Transitional Kindergarten class which serves a similar age group as the center. There are two bathrooms for day care children. The outdoor activity area outside of the room 7A will be used for the children during this period of time The outdoor activity area is fully fenced and the sign in and sign out area will be positioned outside of the classroom door. There are two sections of the outdoor play structure. The higher section will be taped off with caution tape and the children will not be allowed to use the higher section. Teachers will provide supervision to ensure that only the lower section of the play structure is used.

The facility agrees to notify the department if the use of classroom 7A needs to be extended and when the preschool floor installation is completed and the classroom will be reopened.

No deficiencies noted during the visit.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2023
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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