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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010121
Report Date: 06/20/2024
Date Signed: 06/20/2024 11:42:39 AM

Document Has Been Signed on 06/20/2024 11:42 AM - 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 - COUCH INFANT/TODDLERFACILITY NUMBER:
483010121
ADMINISTRATOR/
DIRECTOR:		NGUYEN, THANHFACILITY TYPE:
830
ADDRESS:579 COUCH STREETTELEPHONE:
(707) 252-8931
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: DATE:
06/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Thanh NguyenTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with Site Supervisor, Thanh Nguyen regarding a facility fire which occurred on Monday, June 17 2024. A section of the exterior playground fence on the west side of the preschool play yard was burned. The fire started at 3:43pm. The fire was extinguished by the Vallejo FD. A phone call to LPA Ouye was made by the Site Supervisor on Tuesday, June 18 2024.

The outdoor activity area in the section of the playground closest to the fence has the orange plastic temporary construction fencing to keep children from the burned area.

A restoration management company is on site today to evaluate any materials that may be deemed unhealthy for the children. Plans to clean up and restore the outdoor play area back to it's original state are still being managed.

LPA is requesting the facility to update the department on restoration schedules.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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