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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045406630
Report Date: 03/06/2024
Date Signed: 03/06/2024 04:55:46 PM

Document Has Been Signed on 03/06/2024 04:55 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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CHICO MONTESSORI CHILDREN'S HOUSEFACILITY NUMBER:
045406630
ADMINISTRATOR:LIVINGSTON, SARAHFACILITY TYPE:
850
ADDRESS:814 GLENN STREETTELEPHONE:
(530) 342-5518
CITY:CHICOSTATE: CAZIP CODE:
95928
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 5DATE:
03/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:18 PM
MET WITH:Mary Beth Allen - Director TIME COMPLETED:
05:05 PM
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An unannounced case management inspection was conducted today 3/6/24 at 4:18pm by Licensing Program Analyst (LPA), S. Sims. LPA Sims met with Licensee Sarah Livinston. In response to an Unusual Incident Report received by the Department on 02/23/24 stating that child C1 had fractured their arm but was unsure if the injury was obtained at the facility. C1 had jumped off of the play structure on the playground on 2/22/24 possibly causing injury.

The licensee was interviewed on 3/6/24 at 4:29pm and stated that there was staff providing supervision at the time of the incident and the play structure is marked with red tape at the level it is safe for kids to jump from and C1 jumped from above the red tape. Licensee stated that there was no indication that a fracture had occurred as C1 seemed okay after incident

Two Staff S1-S2 were interviewed on 3/6/24 and stated that C1 did cry at the time of the incident but seemed okay afterwards and had no sign of further injury.

During today’s inspection, the facility was toured and LPA observed 5 children in care.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CHICO MONTESSORI CHILDREN'S HOUSE
FACILITY NUMBER: 045406630
VISIT DATE: 03/06/2024
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Due to insufficient information at this time, further investigation is needed.

A notice of site was given and must remain posted for 30 days. Report was reviewed with Licensee Sarah Livingston.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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