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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455406084
Report Date: 07/25/2019
Date Signed: 07/25/2019 11:57:55 AM

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:SHASTA HEAD START - LAKE CENTERFACILITY NUMBER:
455406084
ADMINISTRATOR:SELLERS, L./GROVES, B.FACILITY TYPE:
850
ADDRESS:375 LAKE BLVD., SUITE 200TELEPHONE:
(530) 241-1036
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:88CENSUS: 22DATE:
07/25/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Heather StevensTIME COMPLETED:
11:15 AM
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The Licensing Program Analysts (LPA's) Snow and Wishart conducted a visit to follow up on incident reports. The first was a report from 2/12/19 and the facility supplied a legible copy of the incident report today; no follow up on a CPS report.
The second Incident was self reported in a timely manor; it was reported that two children ran into each other on the play yard causing injury on 7/11/19. The Director, Heather Stevens stated that the child did not end up needing medical attention and returned to school the following week.


No violations
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019
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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