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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009536
Report Date: 12/17/2021
Date Signed: 12/17/2021 01:09:53 PM

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:ST. ROSE PRESCHOOLFACILITY NUMBER:
493009536
ADMINISTRATOR:OSEGUERA, CLAUDIAFACILITY TYPE:
850
ADDRESS:4300 OLD REDWOOD HIGHWAYTELEPHONE:
(707) 526-9844
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:43CENSUS: DATE:
12/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Center DirectorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Hernandez Torres conducted an unannounced follow-up visit to center due to an Unusual Incident report that was received on December 10th, 2021. LPA Hernandez Torres requested documents and/or any evidence to support the incident that occurred on December 02nd 2021. LPA Interviewed three children between 11:18AM-11:41AM, two teachers between 10:11AM- 10:33AM, and Center Director at 12:05PM.

There were no deficiencies sited at this time.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Elpidia Hernandez TorresTELEPHONE: (707) 771-5568
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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