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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515407170
Report Date: 11/18/2019
Date Signed: 11/18/2019 02:18:02 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:E CENTER HS PGMS - COOPER SITEFACILITY NUMBER:
515407170
ADMINISTRATOR:HOPKINS, KATRINAFACILITY TYPE:
850
ADDRESS:840 COOPER AVENUETELEPHONE:
(530) 634-1200
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY:34CENSUS: DATE:
11/18/2019
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Karen FukushimaTIME COMPLETED:
02:25 PM
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A collateral inspection was made to the facility by Licensing Program Analysts (LPA), Kirk Marks and Sandra Husband. The visit was conducted as a follow up to an annual/random inspection conducted at the E Center Booth facility. The children's files were no longer housed at the Booth site and had been sent to the Cooper site since the school was closed for the year on November 14. Ten children’s records were reviewed at 1:45, and contained identification forms with authorized representative information, as well as medical assessments.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk MarksTELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2019
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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