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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
125400329
Report Date:
08/17/2022
Date Signed:
08/17/2022 10:20:52 AM
Document Has Been Signed on
08/17/2022 10:20 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
CCLD Regional Office
,
520 COHASSET RD., SUITE 170
CHICO
,
CA
95926
FACILITY NAME:
WINGE, NORA FAMILY CHILD CARE HOME
FACILITY NUMBER:
125400329
ADMINISTRATOR:
WINGE, NORA M.
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(707) 442-4230
CITY:
ARCATA
STATE:
CA
ZIP CODE:
95521
CAPACITY:
14
CENSUS:
10
DATE:
08/17/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:45 AM
MET WITH:
Nora Winge
TIME COMPLETED:
10:45 AM
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LPA Lynch visited the home today for the purpose of a case-management visit. LPA observed care and supervision and staffing ratio and capacity requirements were met during today's visit. No deficiencies were cited during today's visit.
SUPERVISOR'S NAME:
Erin Virrueta
TELEPHONE:
(530) 895-4325
LICENSING EVALUATOR NAME:
Kiriko Lynch
TELEPHONE:
(530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE:
08/17/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/17/2022
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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