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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008727
Report Date: 11/16/2023
Date Signed: 11/16/2023 01:49:27 PM


Document Has Been Signed on 11/16/2023 01:49 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 GOLD RIDGE PRESCHOOLFACILITY NUMBER:
493008727
ADMINISTRATOR:COPELAND, JENNYFACILITY TYPE:
850
ADDRESS:1455 GOLF COURSE DRIVETELEPHONE:
(707) 586-1253
CITY:ROHNERT PARKSTATE: CAZIP CODE:
94928
CAPACITY:71CENSUS: 30DATE:
11/16/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Claudia Avalos, Site SupervisorTIME COMPLETED:
02:01 PM
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A case management visit was made to the facility by Licensing Program Analsyt (LPA) Y. Yang to inspect "classroom A" and re approve it for childcare use. The LPA was previously notified by Site Supervisor Avalos on 09/25/23 that the classroom was temporarily out of service due to construction work inside the classroom. During today's visit, the LPA inspected the classroom and observed that there have been no changes made to the room's useable square footage or the number of toilets and sinks available for children. The site supervisor informed the LPA that new vinyl flooring was installed inside the classroom along with new two new toilets and sinks inside the adjacent children's bathroom. This classroom has been re approved for childcare use.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the site supervisor, Claudia Avalos. 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: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2023
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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