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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
493008800
Report Date:
04/08/2022
Date Signed:
04/08/2022 01:35:19 PM
Document Has Been Signed on
04/08/2022 01:35 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:
STARS PRESCHOOL-GUERNEVILLE
FACILITY NUMBER:
493008800
ADMINISTRATOR:
BLACKNER, REBECCA
FACILITY TYPE:
850
ADDRESS:
14630 ARMSTRONG WOODS ROAD
TELEPHONE:
(707) 869-8106
CITY:
GUERNEVILLE
STATE:
CA
ZIP CODE:
95446
CAPACITY:
24
TOTAL ENROLLED CHILDREN:
24
CENSUS:
14
DATE:
04/08/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
11:45 AM
MET WITH:
Jynx Lopez
TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Glenn Ouye arrived to conduct a capacity determination for the child care center. LPA Ouye toured the site with licensee Jynx Lopez.
The facility's interior and exterior activity space for children was measured. There is sufficient interior and exterior activity space to support the current capacity The site has four sinks and two toilets for the children in care.
No deficiencies during the visit.
SUPERVISORS NAME
:
Leslie Lepori
LICENSING EVALUATOR NAME
:
Glenn Ouye
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/08/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/08/2022
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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