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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297003934
Report Date: 09/15/2021
Date Signed: 09/15/2021 01:13:41 PM

Document Has Been Signed on 09/15/2021 01:13 PM - It Cannot Be Edited

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., STE. 170
CHICO, CA 95926
FACILITY NAME:ALL-STAR PROGRAMSFACILITY NUMBER:
297003934
ADMINISTRATOR:COOK, JEFFERY C.FACILITY TYPE:
775
ADDRESS:10140 WILD TURKEY LANETELEPHONE:
(530) 432-6564
CITY:SMARTSVILLESTATE: CAZIP CODE:
95977
CAPACITY: 24CENSUS: 8DATE:
09/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jean-Claude CookTIME COMPLETED:
02:00 PM
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LPA Lusby arrived on Wednesday September 15, 2021 to conduct the annual inspection. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

LPA and Jean-Claude toured the facility together. At this time, facility is conducting all virtual classes. In the areas toured, no immediate health, safety, or personal rights violations were observed.

LPA and Jean-Claude completed the infection control domain together and facility was found to be in substantial compliance at this time.

No deficiencies are being cited as a result of todays inspection. Exit interview conducted. A copy of this report was left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Melissa Lusby
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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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