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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010019
Report Date: 12/18/2020
Date Signed: 12/21/2020 08:07:18 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:4CS MEADOW PRESCHOOLFACILITY NUMBER:
493010019
ADMINISTRATOR:MCINTYRE, AMYFACILITY TYPE:
850
ADDRESS:880 MARIA DRIVETELEPHONE:
(707) 544-3077
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:45CENSUS: DATE:
12/18/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amy McIntyreTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with Program Director, Amy McIntyre to conduct a case management visit to determine the capacity for this center application. LPA advised the Program Director that the would be drafted off site and emailed to her.

The facility has two classrooms and share a large outdoor play area.

The fire inspection was conducted on 12/17/2020 and received by the department on 12/18/2020. There are operational carbon monoxide and smoke detectors and fire extinguisher present in the facility. LPA emailed a copy of the approved fire inspection to the Program Director.

The interior and exterior square footage was measured. A capacity determination worksheet will be place in the file.

The interior square footage: 1515 sq ft.
The exterior square footage: 4400 sq ft.
4 toilets
4 sinks

Based on the interior square footage of 1515 sq ft, the maximum capacity is approved for 43 children. LPA advised the Program Director that the application requested capacity of 45 cannot be approved due to the interior square footage and that 43 children can be approved when the license is ready for approval.
The Program Director agreed to email LPA Ouye a copy of the teacher and parent handbook. The program copy is in the Rohnert Park Child Care Office however LPA asked for an emailed copy to review due to LPA's teleworking due to the Covid-19 pandemic.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2020
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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