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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121373988
Report Date: 05/26/2022
Date Signed: 05/26/2022 08:53:16 PM


Document Has Been Signed on 05/26/2022 08:53 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:HEAD START - WORTHINGTONFACILITY NUMBER:
121373988
ADMINISTRATOR:YORK, CHRISTINAFACILITY TYPE:
850
ADDRESS:3460 ERIE STREETTELEPHONE:
(707) 443-1142
CITY:EUREKASTATE: CAZIP CODE:
95501
CAPACITY:40CENSUS: 0DATE:
05/26/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Abraxas LaytonTIME COMPLETED:
05:00 PM
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 On May 26, 2022 at 2pm the facility by Licensing Program Analyst (LPA), Snow went to the administrative office for NORTHCOAST CHILDREN'S SERVICES located at 1266 9th street in Arcata to meet with Abraxas Layton and discuss faucets that tested positive for lead. A follow-up up visit will be made,

No violations were issued today
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-5033
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2022
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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