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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 123007301
Report Date: 01/30/2020
Date Signed: 01/30/2020 12:35:31 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:MAD RIVER MONTESSORI PRESCHOOLFACILITY NUMBER:
123007301
ADMINISTRATOR:DILORENZO, JULIEFACILITY TYPE:
850
ADDRESS:1710 JANES ROADTELEPHONE:
(707) 822-4027
CITY:ARCATASTATE: CAZIP CODE:
95521
CAPACITY:30CENSUS: 28DATE:
01/30/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Julie DilorenzoTIME COMPLETED:
01:00 PM
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 Licensing Program Analyst (LPA) Lynch visited the center today for the purpose of a case management - incident, which was reported by the facility on 09/26/19. LPA met with Director, and inspected the area where the incident occurred. LPA interviewed staff regarding care and supervision on the day of the incident, and obtained the written report regarding the incident. LPA did not observe or note any violations.

No Title 22 deficiencies were cited during today's visit. Notice of Site Visit posted.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
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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