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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 085403406
Report Date: 09/13/2023
Date Signed: 09/13/2023 04:09:39 PM

Document Has Been Signed on 09/13/2023 04:09 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-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:NORTHCOAST CHILDREN'S SERVICES INFANT TODDLER CENTFACILITY NUMBER:
085403406
ADMINISTRATOR:ATEN, COLLIENFACILITY TYPE:
830
ADDRESS:860 SMALL AVENUETELEPHONE:
(707) 465-4807
CITY:CRESCENT CITYSTATE: CAZIP CODE:
95531
CAPACITY: 20TOTAL ENROLLED CHILDREN: 16CENSUS: 5DATE:
09/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Gay HafleyTIME COMPLETED:
04:30 PM
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LPAs K. Lynch and N. Wheeler went to the facility for the purpose of an unusual incident report case management visit self-reported by the facility on 07/11/23. LPAs met with the Center Director/Regional Supervisor Gay Hafley, and conducted an interview and discussed the incident. She stated the Licensee, NCS conducted an internal investigation and reported the incident to Licensing and Head Start. LPAs requested records related to the incident in regards to the investigation and findings. No citations issued at today's visit. Exit interview conducted with Center Director/Regional Supervisor.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2023
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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