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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010425
Report Date: 06/14/2023
Date Signed: 06/14/2023 04:26:13 PM

Document Has Been Signed on 06/14/2023 04:26 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:PLEASANT HILL CHRISTIAN PRESCHOOLFACILITY NUMBER:
493010425
ADMINISTRATOR:CONRRIQUE, RACHELFACILITY TYPE:
850
ADDRESS:1782 PLEASANT HILL ROADTELEPHONE:
(707) 823-5868
CITY:SEBASTOPOLSTATE: CAZIP CODE:
95472
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: DATE:
06/14/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Rachel ConrriqueTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with the applicant.
LPA measured the interior square footage. There is sufficient square footage to support the applicants capacity request of 15 children. The limit of capacity is 15 because there is one toilet for the children. There are two sink inside the classroom. The smoke and carbon monoxide detectors were tested and functional and there is a fire extinguisher rated at 2A10BC.

There are sufficient equipment, furniture and toys for the inside and exterior of the facility. Sign in and sign out log will be located at the front door or just outside of the front door, depending on weather. The outdoor play structure is rated for 2-5 years of age.

The applicant is finalizing the outdoor activity area. LPA is still conducting the review of the application. The approved fire clearance was received on June 14, 2023.

LPA will return to do the final approval when the outdoor activity area and the application review is completed.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2023
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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