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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
455406084
Report Date:
02/07/2020
Date Signed:
02/07/2020 02:24:11 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:
SHASTA HEAD START - LAKE CENTER
FACILITY NUMBER:
455406084
ADMINISTRATOR:
STEVENS, HEATHER
FACILITY TYPE:
850
ADDRESS:
375 LAKE BLVD., SUITE 200
TELEPHONE:
(530) 241-1036
CITY:
REDDING
STATE:
CA
ZIP CODE:
96003
CAPACITY:
88
CENSUS:
DATE:
02/07/2020
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
Tessa Buell
TIME COMPLETED:
09:15 AM
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The LPA conducted a visit to conduct a records review.
No violations were observed
SUPERVISOR'S NAME:
Megan Aviles
TELEPHONE:
(530) 895-5984
LICENSING EVALUATOR NAME:
Jaime Snow
TELEPHONE:
(530) 215-6132
LICENSING EVALUATOR SIGNATURE:
DATE:
02/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/07/2020
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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