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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006288
Report Date: 03/06/2024
Date Signed: 03/06/2024 12:58:42 PM


Document Has Been Signed on 03/06/2024 12:58 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:LA PETITE ACADEMY - SCHOOL AGE/WINDSORFACILITY NUMBER:
493006288
ADMINISTRATOR:JAMIE POMAFACILITY TYPE:
840
ADDRESS:9451 BROOKS ROADTELEPHONE:
(707) 838-0549
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:20CENSUS: 0DATE:
03/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Jenny Wittry, Interim Center DirectorTIME COMPLETED:
12:07 PM
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A confirmation of closure- case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang. The LPA met with the interim center director, Jenny Wittry today. On 02/23/24, the center's former center director, Jamie Poma notified the Department in writing via Certification of Non-Operation form that the center's school age license was no longer active and wishes to surrender the license effective 02/23/24.

During today's case management visit, the LPA toured the former school age classroom and observed no school age children in care. The interim center director notified the LPA that the classroom was re purposed for preschool use; there are no changes to the preschool license's capacity. The LPA inspected the classroom and the play yard to ensure that the equipment in the room and on the play yard is age appropriate. The classroom and play yard have been approved for preschool use. During today's visit, the LPA obtained an updated floor sketch and emergency disaster plan from the interim center director.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the interim center director, Jenny Wittry. There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024
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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