Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493005994
Report Date: 03/15/2016
Date Signed: 03/15/2016 12:09:32 PM

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:WILLOW TREE SCHOOL - PRESCHOOLFACILITY NUMBER:
493005994
ADMINISTRATOR:INEZ DUVALLFACILITY TYPE:
850
ADDRESS:137 PAYRAN STREETTELEPHONE:
(707) 763-2546
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:22CENSUS: 18DATE:
03/15/2016
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Cherie StillTIME COMPLETED:
12:00 PM
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LPA Vickie Capurso-Valles conducted a POC visit and met with Director Cherie Still. Present were 3 teachers with 18 children, plus the director. Ratio is met. The licensee bought a carbon monoxide detector. LPA confirmed it does work. The director also created a staff schedule of breaks, so the breaks are now staggered. Plans of Corrections for both citations are now cleared.

Notice of Site Visit posted.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Victoria Capurso-VallesTELEPHONE: (707) 588-5077
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2016
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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