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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 354416171
Report Date: 07/14/2021
Date Signed: 07/14/2021 10:37:53 AM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:CALAVERAS HEAD STARTFACILITY NUMBER:
354416171
ADMINISTRATOR:RENEE GARCIAFACILITY TYPE:
850
ADDRESS:1081 BUENA VISTA ROADTELEPHONE:
(408) 573-4071
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:72CENSUS: 0DATE:
07/14/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Rocio LitleTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Deanna Villagrana met with Site Supervisor Rocio Litle for a Required 1 year visit. The school is closed until August 23, 2021 and no kids were present. A continuation required visit will be conducted when school is in session.

No deficiency was sited during visit.

A Notice of Site was issued and must be posted for 30 days.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Deanna VillagranaTELEPHONE: (408) 335-9890
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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