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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006901
Report Date: 02/08/2023
Date Signed: 02/08/2023 12:16:42 PM


Document Has Been Signed on 02/08/2023 12:16 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 WILLOW CREEK STATE PRESCHOOLFACILITY NUMBER:
493006901
ADMINISTRATOR:SCHAEFER, PAULAFACILITY TYPE:
850
ADDRESS:2536 MARLOW ROADTELEPHONE:
(707) 570-2607
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:24CENSUS: 0DATE:
02/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Paula Schaefer and Jim WaltersTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with the director and Jim Walters to measure the facility's interior square footage. The program is considering a capacity increase to operate a hybrid program with a half day and full day program.

The interior square footage of 1,123.25 supports 32 children. There are currently two toilets and two sinks for the program. Mr. Walters indicated that if the licensee seeks a capacity increase to 32 children, an additional toilet and sink would be added to meet the 1:15; sink/toilet to children ratio.

The licensee will submit a capacity increase application when the program is ready to increase the capacity.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
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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