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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002981
Report Date: 12/22/2022
Date Signed: 12/22/2022 10:25:36 AM

Document Has Been Signed on 12/22/2022 10:25 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 - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:IPS DAY PROGRAM #2FACILITY NUMBER:
455002981
ADMINISTRATOR:GOMEZ-ZUMKEHR, AMANDAFACILITY TYPE:
775
ADDRESS:2580 S BONNYVIEW RD #CTELEPHONE:
(530) 244-7928
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY: 35CENSUS: 0DATE:
12/22/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Amanda Gomez-ZumkehrTIME COMPLETED:
10:30 AM
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LPA Hiratsuka, conducted this announced prelicensing visit. LPA met with Administrator Amanda Gomez-Zumkehr. LPA wore surgical mask and observed staff wore surgical mask.

This facility is undergoing a change of location. This building has 10 classrooms. The main entrance opens to a small foyer area that is going to be used to screen clients. From there is a second set of doors that leads to the classrooms and office area. Most of the classrooms have a Jack-and-Jill set up with restrooms with sinks in the classrooms. There are a couple that do not. At the end of the hallway on the right are common restrooms. There are exits on both sides. There is a small break room of the left. There is a fenced in area outside for activities.


A couple of topics discussed


This facility meets regulations. LPA is going to submit this to the application specialist.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2022
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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