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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483001097
Report Date: 08/21/2024
Date Signed: 08/21/2024 03:22:21 PM

Document Has Been Signed on 08/21/2024 03:22 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:HEAD START - KIDDERFACILITY NUMBER:
483001097
ADMINISTRATOR/
DIRECTOR:		CHAND, VERONICAFACILITY TYPE:
850
ADDRESS:1657 KIDDER AVENUETELEPHONE:
(707) 304-2015
CITY:FAIRIFELDSTATE: CAZIP CODE:
94533
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
08/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:
Veronica Chand		TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Site Supervisor Veronica Chand regarding an incident which was reported to have occurred on June 27, 2024. LPA arrived to interview two staff who were not present on this day.

LPA will return to interview the staff on a different day.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/21/2024
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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