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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125407397
Report Date: 09/27/2021
Date Signed: 09/27/2021 03:07:25 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:SMITH LANE EARLY HEAD STARTFACILITY NUMBER:
125407397
ADMINISTRATOR:CROTTY, BETHFACILITY TYPE:
850
ADDRESS:3040 SMITH LANETELEPHONE:
(707) 725-7969
CITY:FORTUNASTATE: CAZIP CODE:
95540
CAPACITY:8CENSUS: 4DATE:
09/27/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Naomi FaulknerTIME COMPLETED:
03:30 PM
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A case management Licensee initiated inspection was conducted by Licensing Program Analyst (LPA) Kiriko Lynch in response to a capacity increase application received on 08/09/21. The facility was toured inside and outside, and the floor and yard plan submitted by the licensee were verified. The Licensee has requested an increase in capacity for the program for a total of 16 preschool age children. The indoor space of the existing two classrooms, and two additional rooms will meet the requested capacity, and the total number of fixtures will be sufficient for the combination program. The existing total exterior space is sufficient for the capacity increase of the program. The fire clearance was received by Licensing on 09/08/21, and was approved by the local fire authority on 08/30/21. Capacity increase is approved today, 09/27/21.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2021
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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