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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125407524
Report Date: 05/15/2023
Date Signed: 05/15/2023 02:16:59 PM

Document Has Been Signed on 05/15/2023 02:16 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:MOORE, LAURA FAMILY CHILD CARE HOMEFACILITY NUMBER:
125407524
ADMINISTRATOR:MOORE, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 460-0129
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 7DATE:
05/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Laura MooreTIME COMPLETED:
02:30 PM
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LPAs Wheeler and Lynch arrived at the home and met with the Licensee regarding an incident which occurred on 05/05/2023, and was self-reported by the Licensee per regulations. LPAs interviewed the Licensee and assistant regarding the incident, toured the area of the home where the incident occurred, and obtained more information regarding the incident. No citations were issued during the visit. Exit interview conducted, appeal rights provided, notice of site visit posted.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Noah Wheeler
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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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