<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
085406051
Report Date:
08/18/2022
Date Signed:
08/18/2022 03:43:33 PM
Document Has Been Signed on
08/18/2022 03:43 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:
LITTLE SCHOOL OF THE REDWOODS
FACILITY NUMBER:
085406051
ADMINISTRATOR:
SILVA, MICHAELLE
FACILITY TYPE:
850
ADDRESS:
860 SMALL AVENUE
TELEPHONE:
(707) 464-4174
CITY:
CRESCENT CITY
STATE:
CA
ZIP CODE:
95531
CAPACITY:
30
TOTAL ENROLLED CHILDREN:
30
CENSUS:
5
DATE:
08/18/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
03:30 PM
MET WITH:
Zakry Conger
TIME COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Lynch visited the facility today to obtain a signature from an amended annual report from 07/08/2022. LPA obtained original signature from facility representative and issued a new copy of the report to representative. Original signature of LPA and facility representative for report is on file.
SUPERVISORS NAME
:
Erin Virrueta
LICENSING EVALUATOR NAME
:
Kiriko Lynch
LICENSING EVALUATOR SIGNATURE
:
DATE:
08/18/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1