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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340306392
Report Date: 10/21/2022
Date Signed: 10/21/2022 01:05:18 PM

Document Has Been Signed on 10/21/2022 01:05 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:ASSOCIATED STUDENTS CSUS CHILDREN'S CENTERFACILITY NUMBER:
340306392
ADMINISTRATOR:VELTE, SHERRYFACILITY TYPE:
850
ADDRESS:6000 J STREETTELEPHONE:
(916) 278-6216
CITY:SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY: 126TOTAL ENROLLED CHILDREN: 126CENSUS: 76DATE:
10/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sherry VelteTIME COMPLETED:
01:00 PM
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On October 21, 2022, Licensing Program Analysts (LPAs) Amanda Sutter and Soleil Marx met with Director Sherry Velte for a case management inspection to discuss the unusual incident report (UIR) that was submitted on September 23, 2022. LPAs observed 76 children supervised by 28 staff.

LPAs conducted interviews and observed care and supervision of children in care.

No deficiencies were cited in today’s visit.

Exit interview was conducted with Director Sherry Velte and notice of site visit was posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2022
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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