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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490104158
Report Date: 05/10/2023
Date Signed: 05/10/2023 05:15:37 PM

Document Has Been Signed on 05/10/2023 05:15 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:ADOBE CHRISTIAN PRESCHOOLFACILITY NUMBER:
490104158
ADMINISTRATOR:LUO, NILIFACILITY TYPE:
850
ADDRESS:2875 ADOBE ROADTELEPHONE:
(707) 762-7713
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: 60TOTAL ENROLLED CHILDREN: 48CENSUS: 44DATE:
05/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Andrea PfeiferTIME COMPLETED:
01:57 PM
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An unannounced case management visit was made to the facility today by Licensing Program Analysts (LPA) Y. Yang and S. Mariani to provide technical assistance to the facility's new center director, Andrea Pfeifer. During today's case management visit, the LPA obtained additional documents from the center director pertaining to the change of director. As of February 09, 2023, Pfeifer is the center director at this facility. A change of director packet was received by the Department on 04/12/23.

A notice of site visit was given and must remain posted for 30 days. This report was read and reviewed with the center director. There were no Title 22 deficiencies cited during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2023
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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