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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
493008802
Report Date:
04/08/2022
Date Signed:
04/08/2022 01:25:46 PM
Document Has Been Signed on
04/08/2022 01:25 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-SEBASTOPOL
FACILITY NUMBER:
493008802
ADMINISTRATOR:
MELISSA NEIGUM
FACILITY TYPE:
850
ADDRESS:
466 JOHNSON STREET
TELEPHONE:
(707) 829-2160
CITY:
SEBASTOPOL
STATE:
CA
ZIP CODE:
95472
CAPACITY:
22
CENSUS:
10
DATE:
04/08/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:30 AM
MET WITH:
Jynx Lopez
TIME COMPLETED:
10:00 AM
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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 three sinks and two toilets for the children in care.
No deficiencies during the visit.
SUPERVISOR'S NAME:
Leslie Lepori
TELEPHONE:
(707) 588-5060
LICENSING EVALUATOR NAME:
Glenn Ouye
TELEPHONE:
(707) 588-5042
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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