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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010083
Report Date: 07/06/2021
Date Signed: 07/06/2021 01:28:56 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:ACHIEVERSFACILITY NUMBER:
493010083
ADMINISTRATOR:KOHLI, DIVYAFACILITY TYPE:
850
ADDRESS:573 SUMMERFIELD ROADTELEPHONE:
(352) 871-2756
CITY:SANTA ROSASTATE: CAZIP CODE:
95405
CAPACITY:90CENSUS: DATE:
07/06/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Neeru Vermani and Heather PetersTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with applicant Neeru Vermani and future Director, Heather Peters to conduct a prelicensing/capacity increase site visit.
The current owner Huia Pope was also present during the inspection.

The application was received by the department on June 7, 2021. The fire inspection request was sent to the Santa Rosa Fire Department. The applicant is having a fire alarm installed which is scheduled for July 27, 2021. The applicant and the existing licensee are seeking a provisional license to start on August 1, 2021. This is an entity change. There is sufficient children equipment, toys and furniture which will remain for the new owners.
There is adequate fall protection which is small pebbles under the climbing structures. The children use individual water bottles for hydration.

LPA Ouye conducted the capacity determination. The applicant is seeking a preschool license for 90 preschool age children. There are 6 toilets and 6 sinks for the children in care. There is sufficient indoor and outdoor activity space for the requested 90 children. A capacity determination worksheet was used to confirm the interior and exterior square footage the number of toilets and sinks for the children

The new applicant will use an electronic sign in and sign out program. There are two fire extinguishers which are rated at 3A40BC which exceeds the regulatory requirement. The carbon monoxide and smoke detectors were tested and operational. The fire alarm was also tested and functional.

LPA Ouye will perform the application review and a final inspection prior to licensure.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021
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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