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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297003934
Report Date: 08/23/2023
Date Signed: 08/23/2023 04:09:12 PM

Document Has Been Signed on 08/23/2023 04:09 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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:
08/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jeff and JC CookTIME COMPLETED:
12:45 PM
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On 8/23/2023 LPA Tryon visited the program site to meet with licensees to do an annual visit. LPA met with Jeff and JC Cook.
LPA did a tour of the program with licensees, including workshop area, classroom area, rest area, outside.
The location is used occasionally; program is more often mobile in the community.
The program has smoke and carbon monoxide detectors, fire extinguishers that are charged and current, first aid supplies, staff and client files and information, staff training, etc.

LPA reviewed the CARE Tool for day programs with licensees.

At this time, the program appears to be in substantial compliance with the regulations.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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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