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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008637
Report Date: 06/06/2024
Date Signed: 06/06/2024 09:35:10 AM

Document Has Been Signed on 06/06/2024 09:35 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:ACORN PRESCHOOL, OAK GROVE UNION SCHOOL DISTRICTFACILITY NUMBER:
493008637
ADMINISTRATOR/
DIRECTOR:		VICTORIA FERNANDEZFACILITY TYPE:
850
ADDRESS:8760 BOWER STREETTELEPHONE:
(707) 823-4930
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/06/2024
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Victoria Fernandez & Connor PowellTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
NARRATIVE
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On 06/06/2024, at 09:00AM, Licensing Program Analyst, Sebastian Phouthavong made an announced Case Management visit to the facility and met with Director, Victoria Fernanadez & Site Superior, Connor Powell today to verify operation at the facility, and to address the facility's forfeiture. Prior to visit, on 02/26/2024, Director notified LPA of the closure.

During the visit, LPA observed no children in care and toured all areas of where care was being provided. There was no evidence of operation and/or childcare being provided at the facility. Director stated that the School District has decided to forfeit the program and the last day of operation was on 06/05/2024. The building will still be used under the School District. Previously, on 04/11/2024 LPA received a Statement of closure from the School District’s Superintendent and during today’s visit received a copy of the facility’s License with Director’s signature and date of closure.

The approval the Closure for the Child Care Center have been met.

Exit interview conducted and report was reviewed with the Director, Victoria Fernanadez & Site Supervisor, Connor Powell

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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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