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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010103
Report Date: 02/15/2022
Date Signed: 02/15/2022 03:29:50 PM

Document Has Been Signed on 02/15/2022 03:29 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:SANDY LOAM MONTESSORIFACILITY NUMBER:
493010103
ADMINISTRATOR:AISHWARYA KANCHARLAFACILITY TYPE:
840
ADDRESS:175 WEST SIERRA AVENUETELEPHONE:
(707) 664-5347
CITY:COTATISTATE: CAZIP CODE:
94931
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 0DATE:
02/15/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Aishwarya Kancharla TIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPA) Glenn Ouye and Yang Yang met with applicant/licensee/director to conduct the prelicensing inspection. The application was received by the department on July 13, 2021. The approved fire inspection was received by the department on February 8, 2022 after a fire suppression and alarm system was installed.
The program is an school age farm based enrichment program.

The interior and exterior of the facility were inspected. The facility has a main activity room, a smaller art room and a kitchen room. All rooms will be used by the program. There is a bathroom with one toilet and sink. There is an additional sink in the kitchen. There is an staff office off the main activity room. There is a combination carbon monoxide and smoke detector which was tested and functional. There is a fire extinguisher rated at 2A10BC near the door leading to the outdoor activity area. The main entrance is located off the main activity room. Sign in and sign out requirements were discussed.

The outdoor activity area is fully fenced and has removable shade sails to provide shade. The outdoor area utilizes a farm based activity approach. There are planter boxes for gardening and open area where the children can partake in planned activities. The children will utilize individual water bottles for personal hydration.

The licensee is aware of the requirement that all staff must have criminal record clearance prior to employment. Emergency disaster drill must be conducted at least every six months and require documentation. The licensee is aware that water lead testing will be required to be completed by January 1, 2023.

The facility has demonstrated sufficient compliance in preparation and is approved for licensure effective February 15, 2022.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
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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