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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010408
Report Date: 05/11/2023
Date Signed: 05/11/2023 12:38:15 PM

Document Has Been Signed on 05/11/2023 12:38 PM - It Cannot Be Edited

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:KONOCTI USD CHILD DEVELOPMENT CENTER P/SFACILITY NUMBER:
173010408
ADMINISTRATOR:ANGEL COPPAFACILITY TYPE:
850
ADDRESS:9345 WINCHESTER STREETTELEPHONE:
(707) 994-6475
CITY:LOWER LAKESTATE: CAZIP CODE:
95457
CAPACITY: 10TOTAL ENROLLED CHILDREN: 10CENSUS: DATE:
05/11/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Angel CoppaTIME COMPLETED:
12:45 PM
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Licensing Program Analysts (LPA's) Glenn Ouye and Sebastian Phouthavong arrived to conduct a prelicensing inspection for the Konocti USD Child Development Center. This is a combination center which has an infant program and a preschool program. The application was submitted on April 7, 2023 for ten preschoolers. The approved fire clearance was received on May 3, 2023.

The preschool program will operate Monday through Friday, 7:00am to 4:30pm.

There are sufficient equipment, toys and furniture for the children. There is one toilet and on sink for the children in care. There is a functional smoke and carbon monoxide detector and a fire extinguisher rated at 2A10BC. The pull station is located next do the main entrance. The children will bring their own lunches, snacks will be supplied.

The outdoor activity area is sufficient square footage for the children in care. The outdoor activity area will be used on a rotational basis with the preschool children. A rotational waiver will be approved for the center. The applicant agrees that the infant program and preschool program will not commingle children when using the outdoor activity area.

The applicant was reminded that all adults 18 years and over responsible for administration or direct supervision of staff, persons who provides care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: KONOCTI USD CHILD DEVELOPMENT CENTER P/S
FACILITY NUMBER: 173010408
VISIT DATE: 05/11/2023
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LPA reviewed with applicant the LIC 311A, Records To Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed [applicant, licensee, or facility representative] of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Exit interview conducted and report was reviewed with the applicant/director Angel Coppa. The facility is approved for licensure which will be effective May 11, 2023.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC809 (FAS) - (06/04)
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