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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009730
Report Date: 02/11/2022
Date Signed: 02/11/2022 09:58:18 AM

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:SONOMA COUNTY FAMILY YMCAFACILITY NUMBER:
493009730
ADMINISTRATOR:JEREMY HODGDONFACILITY TYPE:
830
ADDRESS:2590 PINER ROADTELEPHONE:
(707) 308-3043
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:20CENSUS: 10DATE:
02/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Tracy ImmTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with Director Tracy Imm to conduct a site visit to confirm the capacity of this infant program.

LPA measured the interior and outdoor activity area.

The interior activity space (not including the nap area and other encumbered space) supports up to 42 infants. Tis meets the licensed capacity of 20 children.

The outdoor activity area was also measured. The square footage supports 7 infants. LPA Ouye and the director discussed the need for an outdoor rotation waiver allowing no more than 7 children at any given time in the outdoor activity area. LPA will request to have the director submit a request for the outdoor activity rotation waiver.

LPA Ouye also advised the director that a water lead test is required to be completed by January 1, 2023. PIN 21-21 CCP was emailed to the director.

No deficiencies cited during the inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022
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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