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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125401106
Report Date: 05/16/2024
Date Signed: 05/16/2024 11:52:47 AM

Document Has Been Signed on 05/16/2024 11:52 AM - 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:HEAD START - ALICE BIRNEYFACILITY NUMBER:
125401106
ADMINISTRATOR/
DIRECTOR:		FORD, DELORISFACILITY TYPE:
850
ADDRESS:717 SOUTH AVENUETELEPHONE:
(707) 442-8977
CITY:EUREKASTATE: CAZIP CODE:
95503
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 21DATE:
05/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Deloris FordTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 05/16/2024 Licensing Program Analysts (LPA) Kiriko Lynch and Noah Wheeler visited the facility for the purpose of a case management incident reported by the facility on 05/03/24. LPAs conducted interviews, and requested documentation related to the incident, and further investigation into the incident will be necessary. No citations issued during today's visit. Exit interview conducted with Site Supervisor Deloris Ford, appeal rights provided, and notice of site visit posted.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
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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