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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007916
Report Date: 05/10/2021
Date Signed: 05/10/2021 01:50:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:PETALUMA VILLAGE PRESCHOOLFACILITY NUMBER:
493007916
ADMINISTRATOR:SCHMIDT, CASEY LYNNFACILITY TYPE:
850
ADDRESS:76 OAK STREETTELEPHONE:
(707) 765-2325
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:28CENSUS: 0DATE:
05/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Casey SchmidtTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with Casey Schmidt at 400 Ely Road to do a capacity determination for second preschool location which the licensee is considering purchasing.

The modular home if modifications are done will have a square footage of 1016 interior play area. This equates to 29 children. There are two bathrooms in the building. The licensee plans to have one bathroom changed to have two toilets and two sinks to support the number of preschool children. The other bathroom can remain as a staff bathroom. The licensee plans to have some interior construction work done. The outdoor play area was measured. The outdoor area is fully fenced. The outdoor play area square footage is 6,096. This exceeds the regulatory requirements for 29 children. There are no bodies of water on the property.

The measurement were given to the licensee. She will advise LPA Ouye if she does plan on submitting a preschool application for this site.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2021
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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