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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010122
Report Date: 11/12/2021
Date Signed: 11/12/2021 10:58:42 AM

Document Has Been Signed on 11/12/2021 10:58 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, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:HEAD START - COUCHFACILITY NUMBER:
483010122
ADMINISTRATOR:WINSTON, RHONDAFACILITY TYPE:
850
ADDRESS:579 COUCH STREETTELEPHONE:
(707) 252-8931
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 0DATE:
11/12/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Susan SmithTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with Program Director, Susan Smith to conduct the capacity determination for the preschool program of this combination center. The Center will have the preschool, toddler and infant programs. The toddler component will be part of the infant license.

The preschool age program will utilize 4 classrooms for operations. The square footage amounts to 3,339 square feet between the 4 classrooms. There are 6 toilets and 10 sinks for the children to use.

There is a kitchen in a separate room, offices, a staff break room and separate bathrooms for staff.

There is an interior outdoor atrium for the preschool program that is 484 square feet which will be combined with the outdoor square footage when the playground construction is completed.

The interior and exterior is still under construction. The delay in construction is affected by Covid-19/ supply chain issues. The fire clearance will also be completed when construction is completed. At this point the Program Director hopes to be completed in January 2022.

LPA will return at a later date to measure the outdoor activity area and do the final prelicensing when as the facility nears construction completion.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2021
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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