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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515400854
Report Date: 06/03/2024
Date Signed: 06/03/2024 12:12:54 PM

Document Has Been Signed on 06/03/2024 12:12 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:MARCUM-ILLINOIS PRESCHOOLFACILITY NUMBER:
515400854
ADMINISTRATOR/
DIRECTOR:		IRBY, MARGARETFACILITY TYPE:
850
ADDRESS:2452 EL CENTRO BLVD.TELEPHONE:
(530) 656-2407
CITY:E. NICOLAUSSTATE: CAZIP CODE:
95659
CAPACITY: 36TOTAL ENROLLED CHILDREN: 18CENSUS: 16DATE:
06/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Shasta FordTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On 6/3/2024 at 11:30am, a case management inspection was made to the facility by Licensing Program Analyst (LPA), Laura Chavez in response to Administrative Assistant Shasta Ford stating that in the future the preschool may only operate in Room #16. On this date Room #17 was being used by children enrolled in transitional kindergarten (TK). During todays inspection LPA took measurements of Classroom #16 and completed a Capacity Worksheet. There are a total of 3 toilets, and 4 sinks in the classroom. Two toilets and 2 sinks are available for children.

A notice of site visit was given and must remain posted for 30 days.



An exit interview conducted and report was reviewed with Administrative Assistant Shasta Ford.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Laura Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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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