<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 123006074
Report Date: 02/13/2024
Date Signed: 02/13/2024 10:44:11 AM


Document Has Been Signed on 02/13/2024 10:44 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:PRIME MONTESSORI SCHOOLFACILITY NUMBER:
123006074
ADMINISTRATOR:REDDY, SUJATHAFACILITY TYPE:
850
ADDRESS:527 MAIN STREETTELEPHONE:
(707) 725-1997
CITY:FORTUNASTATE: CAZIP CODE:
95540
CAPACITY:30CENSUS: 18DATE:
02/13/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Sujatha ReddyTIME COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPAs K. Lynch and N. Wheeler visited the facility for the purpose of a case-management visit in response to an inquiry for lead reporting requirements. LPAs verified the lead testing was conducted by a local company on 11/08/22 per Licensee's lead report documentation, and required LIC 9275 and 9276 forms were submitted by the Licensee and completed by the tester to upload to the Water Board Database. Licensee contacted company via phone during the visit to follow up on documentation being uploaded to Water Board Database. No citations issued during today's visit. Exit interview conducted with Licensee, appeal rights provided, notice of site visit provided.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1