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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065407853
Report Date: 12/17/2021
Date Signed: 03/18/2022 02:17:27 PM


Document Has Been Signed on 03/18/2022 02:17 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:SILVA, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
065407853
ADMINISTRATOR:SILVA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 237-9632
CITY:COLUSASTATE: CAZIP CODE:
95932
CAPACITY:14CENSUS: 12DATE:
12/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Maria SilvaTIME COMPLETED:
02:27 PM
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On 12/17/2021 at 1:50pm Licensing Program Analyst (LPA) Laura Chavez conducted an unannounced Case Management inspection to the facility and met with licensee Maria Silva. During today's inspection to the home LPA conducted interviews with C2 and C3.

All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's tele-inspection.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2021
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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