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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009433
Report Date: 07/30/2024
Date Signed: 07/30/2024 10:53:12 AM


Document Has Been Signed on 07/30/2024 10:53 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA CC RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:4CS APPLES AND BANANAS PRESCHOOLFACILITY NUMBER:
493009433
ADMINISTRATOR:SAENZ, NEIRAFACILITY TYPE:
850
ADDRESS:953 SUNSET AVENUETELEPHONE:
(707) 544-4074
CITY:SANTA ROSASTATE: CAZIP CODE:
95407
CAPACITY:69CENSUS: 27DATE:
07/30/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Neira SaenzTIME COMPLETED:
11:03 AM
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LPA Strother arrived at the facility for the purpose of conducting interviews with children and staff. The interviews conducted were concerning a matter related to a complaint investigation unrelated to this licensed facility.

There were no Title 22 deficiencies cited during today's inspection.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with facility representative, Neira Saenz.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Amy StrotherTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
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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