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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493007916
Report Date: 05/11/2021
Date Signed: 05/12/2021 09:00:57 AM

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:
05/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:30 PM
MET WITH:Casey SchmidtTIME COMPLETED:
06:30 PM
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Licensing Program Analyst (LPA) Ouye met with licensee Casey Schmidt after her program closed for the day to conduct a case management visit. The licensee contacted LPA Ouye and indicated that she is going to apply for an increase in capacity. LPA arrived to do a capacity determination. Due to Covid-19 pandemic, LPA asked to conduct the inspection after the children have left for the day.

LPA Ouye measured the interior and outdoor activity area of the facility. The interior square footage is 1,336 sq ft which allows for a maximum capacity of 38 children. There are 2 toilets and 1 urinal which meets regulation 101239(h)(1). There are 3 sinks.

The outdoor activity area is 3,440 sq ft. which exceed the regulatory requirement for 38 children.

LPA Ouye advised licensee, Casey Schmidt that the maximum capacity for her facility is 38 children.

A capacity determination worksheet will be placed in the facility file.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021
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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