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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585408539
Report Date: 01/10/2025
Date Signed: 01/10/2025 11:45:31 AM

Document Has Been Signed on 01/10/2025 11:45 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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:KIDS COUNTRY CARELANDFACILITY NUMBER:
585408539
ADMINISTRATOR/
DIRECTOR:		INGALLS, ASHLEYFACILITY TYPE:
860
ADDRESS:900 OLIVE STTELEPHONE:
(530) 633-9369
CITY:WHEATLANDSTATE: CAZIP CODE:
95692
CAPACITY: 91TOTAL ENROLLED CHILDREN: 91CENSUS: DATE:
01/10/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Deepak SrivastavaTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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LPA Jaime Snow met with applicant representative, Deepak Srivastava to discuss the application for a change of ownership at KIDS COUNTRY CARELAND. The following is required to be updated prior to inspection:
A1 LIC 200A Form Application for Child Care Center License - updated version of form 2023
A6 Monthly Operating Statement (LIC 401) – correct income
A7 Balance Sheet (LIC 403) *NA for public agencies
A9 Personnel Report (LIC 500) – show staffing for preschool and school age from open to close
A14 Facility Sketch (Floor Plan) (LIC 999)- add room numbers and use and bathroom information as requested on a separate document
B3 Job Descriptions – updated as requested on a separate document
B6 Parent Handbook/Program Description/Admission Policies & Procedures/Discipline Policies – updated as requested on a separate document
B8 Admission Agreement (standalone document) – updated as requested on a separate document
B9 Sample Menu – for snacks, a weeks wort of snacks with serving sizes for each age group

Yard waiver- add a reason and regulation number as provided
Director Exemption – please request an exemption for the missing admin units – waiver guidelines provided.
Proof of MMR for Popli Shagun
SUPERVISORS NAME: Mai Lor
LICENSING EVALUATOR NAME: Jaime Snow
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2025
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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