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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115408493
Report Date: 10/16/2024
Date Signed: 10/16/2024 01:00:42 PM

Document Has Been Signed on 10/16/2024 01:00 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:CHAPMAN INFANT AND TODDLERFACILITY NUMBER:
115408493
ADMINISTRATOR/
DIRECTOR:		FRIAS, ARACELIFACILITY TYPE:
860
ADDRESS:221 E. YOLO STTELEPHONE:
(530) 865-1145
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/16/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Heather AulabaughTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Applicant meeting at the Chico RO to go over the application. The following documents are still needed:
Admission Agreement
Sample Menu for 11-36 month olds
Infant Needs and Services Plan for infants
(D) Director: Araceli Frias
1. Board resolution to authorize director (A4)
(AR) Authorized Representative: Heather _
2. Health Screening Report (LIC 503) (A10)
3. Evidence of current tuberculosis clearance
5. Criminal record clearance or exemption associated to the facility:
115408493 CHAPMAN INFANT AND TODDLER
6. Immunization against Measles (MMR), Pertussis (Tdap) Influenza
7. Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC 9108)
8. Mandated reporter training certificate
9. Child Care Center Orientation- Component I - Application Orientation
10. Child Care Center Orientation- Component II - Operations and Record Keeping
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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