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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343606272
Report Date: 11/08/2019
Date Signed: 11/08/2019 02:19:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SETA - CROSSROADS HEAD STARTFACILITY NUMBER:
343606272
ADMINISTRATOR:VOLCHANSKY, LANAFACILITY TYPE:
850
ADDRESS:7322 FLORIN WOODS DRIVETELEPHONE:
(916) 263-3804
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:84CENSUS: 32DATE:
11/08/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Anthy ThaoTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Elvira Sierra met with Lead Teacher, Anthy Thau for an announced Case Management Inspection regarding a self reported Unusual Incident Report (UIR) that was received via fax on 10/22/19 .Unusual Incident occurred on 10/21/19. Upon arrival, LPA observed 30 preschool children, supervised by 9 staff members.

During the inspection, LPAs conducted a tour of the facility, observed the care and supervision of the children and inspected the area where the incident occurred. LPA also conducted interviews with staff and obtained pertaining information.

LPA determined that no violation of Title 22 regulations were violated regarding the incident.

This report was reviewed with Lead Teacher. LPA provided a Notice of Site Visit, which must remain posted for 30 days.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Elvira SierraTELEPHONE: (916) 216-8826
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2019
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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