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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115405947
Report Date: 11/01/2019
Date Signed: 11/01/2019 03:00:48 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:VILLA AVENUE HEAD STARTFACILITY NUMBER:
115405947
ADMINISTRATOR:DUNTSCH, AMANDAFACILITY TYPE:
850
ADDRESS:451 S. VILLA AVENUETELEPHONE:
(530) 934-6596
CITY:WILLOWSSTATE: CAZIP CODE:
95988
CAPACITY:20CENSUS: 0DATE:
11/01/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Director/Teacher Janice AisenbreyTIME COMPLETED:
03:10 PM
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
On 11/01/2019 at 12:55pm Licensing Program Analyst (LPA) arrived at this facility to conduct a Case Management inspection due to this agencies timely self reported written Unusual Incident Report (UIR). The incident date was 10/25/2019 and was in regards to a report of a child to child interaction.

LPA toured the facility, interviewed staff and reviewed and obtained applicable records. There were no children in attendance during LPA's inspection.

LPA will continue this Case Management pending further inquires into the above reported UIR.

This report was reviewed and discussed with Director Aisenbrey.

All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: David WilsonTELEPHONE: (530) 513-0993
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
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