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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121374840
Report Date: 06/26/2024
Date Signed: 06/26/2024 09:17:32 AM


Document Has Been Signed on 06/26/2024 09:17 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 - JEFFERSONFACILITY NUMBER:
121374840
ADMINISTRATOR:ROBERTS, DONNAFACILITY TYPE:
850
ADDRESS:914 B STREETTELEPHONE:
(707) 441-9020
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:20CENSUS: 0DATE:
06/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Marcella ChaffeeTIME COMPLETED:
09:30 AM
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On 06/26/2024, LPA Noah Wheeler made a visit to the facility for the purpose of amending a prior case management visit that happened on 06/19/2024. LPA met with Site Supervisor Marcella Chaffee and explained the reason for the amendment visit. Notice of Site Visit provided and will be posted for 30 days.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Noah WheelerTELEPHONE: 530-895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2024
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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