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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 340306392
Report Date: 03/12/2025
Date Signed: 03/12/2025 02:35:49 PM

Document Has Been Signed on 03/12/2025 02:35 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ASSOCIATED STUDENTS CSUS CHILDREN'S CENTERFACILITY NUMBER:
340306392
ADMINISTRATOR/
DIRECTOR:		VELTE, SHERRYFACILITY TYPE:
850
ADDRESS:6000 J STREETTELEPHONE:
(916) 278-6216
CITY:SACRAMENTOSTATE: CAZIP CODE:
95819
CAPACITY: 126TOTAL ENROLLED CHILDREN: 126CENSUS: 86DATE:
03/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Samantha SubuyajTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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On March 12, 2025, Licensing Program Analysts (LPAs) Amanda Sutter and Mandie Goodwin met with Associate Director Samantha Subuyaj for a case management inspection to discuss the unusual incident report (UIR) that was submitted on March 1, 2025. Upon arrival, LPAs observed 86 children supervised by 25 staff.

LPAs made observations, gathered documents, and conducted interviews.

No deficiencies were cited in today’s visit.

Exit interview was conducted with Associate Director Samantha Subuyaj and notice of site visit was posted.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Amanda Sutter
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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