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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525402367
Report Date: 06/06/2023
Date Signed: 06/06/2023 03:56:34 PM


Document Has Been Signed on 06/06/2023 03:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:EVERGREEN STATE PRESCHOOLFACILITY NUMBER:
525402367
ADMINISTRATOR:RULON, CRYSTALFACILITY TYPE:
850
ADDRESS:19415 HOOKER CREEK ROADTELEPHONE:
(530) 347-3411
CITY:COTTONWOODSTATE: CAZIP CODE:
96022
CAPACITY:48CENSUS: 29DATE:
06/06/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Crystal Rulon- DirectorTIME COMPLETED:
04:15 PM
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Licensing Program Analysts (LPA), Pearl DiGenova and Sydney Sims conducted a case management facility inspection on 6/6/23 at 3:00 PM. This inspection was in response to an application for increased capacity that was received by the Department. The licensee has requested a capacity increase from 48 to 72 children. The facility is adding room 30 to the existing preschool in rooms 29 and 31.

The LPA toured the facility's new room and outdoor areas. The indoor space of all 3 classrooms and outdoor play space is sufficient for 72 children. There are a total of 3 toilets and 6 sinks in the classrooms for children's use. The facility operates during the school year, 8:00 AM to 3:00 PM. The fire clearance was approved on 5/4/2023.



Licensee must add 2 additional toilets for the increase of capacity to be granted. Space is available in room 30 for the additional bathrooms.

The report was reviewed and discussed with the director Crystal Rulon.

Notice of Site Visit was given to licensee to post for 30 days.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Pearl DiGenovaTELEPHONE: 530-895-5821
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023
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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