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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493005826
Report Date: 07/16/2024
Date Signed: 07/16/2024 09:43:32 AM

Document Has Been Signed on 07/16/2024 09:43 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:4CS PAULIN CREEK CDC - PRESCHOOLFACILITY NUMBER:
493005826
ADMINISTRATOR/
DIRECTOR:		ALI ALHAJ, NADIAFACILITY TYPE:
850
ADDRESS:2614 PAULIN DRIVETELEPHONE:
(707) 565-3420
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 0DATE:
07/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Nadia Ali AlhajTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Glenn Ouye met with Site Supervisor Nadia Ali Alhaj to conduct a confirmation of closure site visit. The facility will be relocating to a new location in Santa Rosa. A change of location application was submitted to the department on June 28, 2024 by the licensee. All staff that will be relocating to the new location have had their background clearance transferred to the new facility license number. The last day of services for the children at this site was Friday, July 12, 2024.

LPA Ouye will process the closure of this site. The closure will be effective July 16, 2024.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
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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