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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045404936
Report Date: 10/03/2024
Date Signed: 10/03/2024 02:58:18 PM

Document Has Been Signed on 10/03/2024 02:58 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:E CENTER HS PGMS - MARIPOSA CENTERFACILITY NUMBER:
045404936
ADMINISTRATOR/
DIRECTOR:		BUTLER, HEATHERFACILITY TYPE:
850
ADDRESS:2603 MARIPOSATELEPHONE:
(530) 343-0633
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
10/03/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Karen Fukushima TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Office meeting to go over applicaiton from July 1, 2024.
To add infant and toddler components to the existing preschool & conversion to single license. Please correct or submit the following:
A1. Application (LIC 200A)
Correct infant age and send an original (0-24 months)

A6. Monthly Operating Statement (LIC 401)

A9. Personnel Report (LIC 500)
Needs to match the existing job titles,
Needs to show infant toddler & preschool staffing separately
Needs to reflect full capacity
Needs to cover all hours open (745am-5pm)

A12. Emergency Care and Disaster Plan (LIC 610)
Need relocation permission letters for South Oroville Community Center
Need one for the infant toddler building
Need a separate on for the preschool building- should show different staff
Please show utility cut off locations *can be simplified like west side of building A
see next page
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: E CENTER HS PGMS - MARIPOSA CENTER
FACILITY NUMBER: 045404936
VISIT DATE: 10/03/2024
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A14. Facility Sketch (floor plot plans- LIC 999 or 8½ x 11 sheet)
SEE THE GUIDE PROVIDED TODAY
Inside- please include measurements, bathrooms, isolation area
Yard- provide yard sketches that include fences and measurements
Birdseye- please provide a map of the property that shows where the rooms and yards are located. Include other buildings and designated use if other programs are on the property.

A15. New Clearance
provide room numbers & infant age so we can order a corrected fire clearance

B6. Parent Handbook
Please send a version that can be printed single side on 8x11.

B7. Schedule of Daily Activities
Separately for infants, toddlers and Preschool

B9. Sample Menus
Separately for infants, toddlers and Preschool

B14. Background Clearance or Exemption
Jodi Keller Must be associated.

Additional Documents:
Request a waiver for a shared infant toddler yard

New Director: Fox
Board resolution to authorize director (A4)
letter of experience
Personnel Record (LIC 501) (A9)
EMSA pediatric First Aid, CPR
Preventive health practices course, including Childhood Nutrition and Lead Exposure
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024
LIC809 (FAS) - (06/04)
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