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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
455406912
Report Date:
03/16/2020
Date Signed:
03/18/2020 11:27:01 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 - OAK VIEW EHS
FACILITY NUMBER:
455406912
ADMINISTRATOR:
KNOWLES, CHRISTINA
FACILITY TYPE:
830
ADDRESS:
1156 DEL MONTE CT.
TELEPHONE:
(530) 722-9114
CITY:
REDDING
STATE:
CA
ZIP CODE:
96002
CAPACITY:
16
CENSUS:
0
DATE:
03/16/2020
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
08:00 AM
MET WITH:
Michelle Epp - Site Supervisor
TIME COMPLETED:
08:55 AM
NARRATIVE
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Report Amended and information transferred to correct license number.
SUPERVISOR'S NAME:
Megan Aviles
TELEPHONE:
(530) 895-5984
LICENSING EVALUATOR NAME:
Carrie Wisehart
TELEPHONE:
(530) 895-5824
LICENSING EVALUATOR SIGNATURE:
DATE:
03/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/16/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
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 - OAK VIEW EHS
FACILITY NUMBER:
455406912
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE:
03/16/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:
Megan Aviles
TELEPHONE:
(530) 895-5984
LICENSING EVALUATOR NAME:
Carrie Wisehart
TELEPHONE:
(530) 895-5824
LICENSING EVALUATOR SIGNATURE:
DATE:
03/16/2020
I acknowledge receipt of this form and understand my
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/16/2020
LIC809
(FAS) - (06/04)
Page:
2
of
2