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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125406606
Report Date: 02/12/2025
Date Signed: 02/12/2025 11:18:44 AM

Document Has Been Signed on 02/12/2025 11:18 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:SURBAUGH, NINA FAMILY CHILD CARE HOMEFACILITY NUMBER:
125406606
ADMINISTRATOR/
DIRECTOR:		SURBAUGH, NINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 832-6327
CITY:MCKINLEYVILLESTATE: CAZIP CODE:
95519
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 10DATE:
02/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Nina SurbaughTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 02/12/2025, Licensing Program Analysts (LPA) Kiriko Lynch and Noah Wheeler visited the facility for the purpose of a case management incident reported by the Licensee on 02/05/25. LPAs conducted an interview, toured the facility where the incident happened, requested documentation related to the incident, and further investigation into the incident will be necessary. No citations issued during today's visit. Exit interview conducted with Licensee Nina Surbaugh, appeal rights provided, and notice of site visit posted.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Kiriko Lynch
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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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