Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 490102569
Report Date: 11/02/2017
Date Signed: 11/08/2017 10:49:26 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:GAN ISRAEL PRESCHOOLFACILITY NUMBER:
490102569
ADMINISTRATOR:LAURITZEN, LESLEEFACILITY TYPE:
850
ADDRESS:740 WESTERN AVENUETELEPHONE:
(707) 763-5136
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:24CENSUS: 23DATE:
11/02/2017
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Leslee Lauritzen, DirectorTIME COMPLETED:
10:30 AM
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A case management licensee initiated inspection was conducted by Licensing Program Analyst (LPA) N.Cunningham in response to an increase capacity application received on 10/10/17 requesting an increase from 24 to 35 children. The indoor space is sufficient for 35 children. There is a total of four sinks, four toilets and two urinals for this licensed program. The outdoor fenced play area space is sufficient for the increased capacity requested of 35. The approved fire clearance for a capacity of 35 was received on 10/20/17. During today's visit, the facility was operating within the licensed capacity and ratio requirements. The facility was toured. No deficiencies were observed. The increase capacity to 35 preschool children is granted. The report was reviewed and discussed with the director. All licensing reports are public information and must be made available upon request.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Nicolette CunninghamTELEPHONE: 707-588-5058
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2017
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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