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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493000856
Report Date: 06/02/2022
Date Signed: 06/02/2022 10:42:38 AM

Document Has Been Signed on 06/02/2022 10:42 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:RIEBLI EXTENDED CHILD CAREFACILITY NUMBER:
493000856
ADMINISTRATOR:MARLEE PATEREAUFACILITY TYPE:
840
ADDRESS:305 MARK WEST SPRINGS ROADTELEPHONE:
(707) 545-2402
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 182TOTAL ENROLLED CHILDREN: 182CENSUS: 0DATE:
06/02/2022
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Jason RiggsTIME COMPLETED:
10:52 AM
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LPA Strother made an announced inspection meeting with Executive Director of Extended Child Care, Jason Riggs for the purpose of adding two classrooms to the license for use over the summer months. Riggs has requested to add classroom #15 and #17 to the license and remain at a total capacity of 182. The following documents were obtained during today's inspection: LIC999, facility sketch update to include classrooms #15 and #17 and previously licensed classrooms #18, #19 and portables A, B, C & D, an updated LIC200A application for a child care center license, LIC500 Personnel Report and a copy of functioning school site John B. Riebli Elementary School’s fire inspection showing no violations dated 01/26/22.

LPA Strother inspected classroom #15 and #17 during the visit. The classrooms were unoccupied and were in the process of being prepared for use. The floors, desks and other equipment and surfaces appeared to be clean, toxic free, safe and in good condition, no hazards were observed. LPA discussed the requirement to keep hand sanitizer, white board cleaner and other toxic items out of reach of children in care.

Additional classrooms #15 and #17 are approved for use by Riebli Extended Child Care as of today, 06/02/22.

SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Amy Strother
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2022
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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