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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
123007037
Report Date:
08/22/2019
Date Signed:
08/22/2019 05:47:32 PM
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:
CHILDREN'S COTTAGE PRESCHOOL, THE
FACILITY NUMBER:
123007037
ADMINISTRATOR:
MCCUTCHEN, ROSE
FACILITY TYPE:
850
ADDRESS:
1807 HARRISON AVENUE
TELEPHONE:
(707) 445-4383
CITY:
EUREKA
STATE:
CA
ZIP CODE:
95501
CAPACITY:
30
CENSUS:
25
DATE:
08/22/2019
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
04:00 PM
MET WITH:
Leah Sanders
TIME COMPLETED:
06:00 PM
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The LPA conducted a visit to follow up on a self reported an incident where a child ran into an outside wall causing a broken arm. The child has a behavior of running into things on purpose and had been redirected prior to this incident. The facility plans on closely monitoring this behavior in the future.
There were no violations issued during todays visit.
SUPERVISOR'S NAME:
Megan Aviles
TELEPHONE:
(530) 895-5984
LICENSING EVALUATOR NAME:
Jaime Snow
TELEPHONE:
(530) 215-6132
LICENSING EVALUATOR SIGNATURE:
DATE:
08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/22/2019
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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