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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 123005139
Report Date: 12/15/2022
Date Signed: 12/15/2022 09:47:55 AM


Document Has Been Signed on 12/15/2022 09:47 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:BROOKS, LYNDA FAMILY CHILD CARE HOMEFACILITY NUMBER:
123005139
ADMINISTRATOR:BROOKS, LYNDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 443-2621
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:14CENSUS: 0DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:John BrooksTIME COMPLETED:
10:00 AM
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LPA Lynch arrived at the home to conduct an unannounced annual inspection, and was told by the Licensee's spouse during the visit their family child care home will be going inactive for the time being. LPA provided the request for inactive status form to Licensee's spouse, and he provided the signed form back to LPA during the visit.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022
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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