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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010061
Report Date: 05/13/2021
Date Signed: 06/16/2021 09:08:52 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 MARK WEST PRESCHOOLFACILITY NUMBER:
493010061
ADMINISTRATOR:AVALOS, CLAUDIAFACILITY TYPE:
850
ADDRESS:4600 LAVELL ROADTELEPHONE:
(707) 522-1413
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY:24CENSUS: DATE:
05/13/2021
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Amy McIntyreTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Amy McIntyre to conduct a prelicensing inspection of the 4C's Mark West Preschool. The application for this facility was received by Community Care Licensing on May 3, 2021. The Sonoma County Fire Inspector was on site and completed his fire safety inspection at the time of the visit. He indicated that the facility has passed the fire clearance. He sent the approved fire safety inspection on the same day.

LPA inspected the classroom and the outdoor activity area which is located at the Mark West Preschool. The interior and exterior activity areas were measured to verify capacity requirements. The areas meet the square footage requirements to support 24 children. There are two sinks and two toilets for the children in care. There are functional smoke and carbon monoxide detectors and fire extinguisher that meets or exceeds the 2A10BC minimum rating.

The outdoor activity area is fully fenced. There is a blacktop play area and a smaller play structure with wood chip fall protection.

The facility will post all required posting in a conspicuous space. LPA Ouye and Amy McIntyre discussed the facility's covid-19 protocols. The center will conduct covid-19 mitigation safety which as used in all 4C's centers. This covers daily health screening and temperature checks, hand washing, sanitation and masking.

The facility is approved for licensure effective June 14, 2021.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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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