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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010061
Report Date: 06/27/2024
Date Signed: 06/27/2024 09:15:46 AM

Document Has Been Signed on 06/27/2024 09:15 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:4CS MARK WEST PRESCHOOLFACILITY NUMBER:
493010061
ADMINISTRATOR/
DIRECTOR:		ROSE ANDRADEFACILITY TYPE:
850
ADDRESS:4600 LAVELL ROADTELEPHONE:
(707) 522-1413
CITY:SANTA ROSASTATE: CAZIP CODE:
95403
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/27/2024
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Site Supervisor, Rosie AndradeTIME VISIT/
INSPECTION COMPLETED:
09:20 AM
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On 08/30/2024 at 08:30AM, Licensing Program Analyst, Sebastian Phouthavong made an announced Case Management visit to the facility and met with Site Supervisor, Rosie Andrade today to verify operation at the facility, and to address the facility's forfeiture. Prior to visit, on 04/19/2024, Program Director Jenny Copeland notified the department 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. Site Supervisor stated the facility’s classroom will be used under the School District. Furthermore, the Site Supervisor stated the last day of operation was on 06/21/2024 and on 06/28/2024 the facility will be completely removed. LPA received copy of the facility’s License with Site Supervisor’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 Site Supervisor, Rosie Andrade


LPA emailed a copry of the report to Program Director Jenny Copeland
Leslie Lepori
Sebastian Phouthavong
DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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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