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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604911
Report Date: 09/02/2021
Date Signed: 09/02/2021 12:15:50 PM

Document Has Been Signed on 09/02/2021 12:15 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:SETA - JOB CORPS HEAD STARTFACILITY NUMBER:
343604911
ADMINISTRATOR:CHERYL DAWSONFACILITY TYPE:
850
ADDRESS:3100 MEADOWVIEW ROADTELEPHONE:
(916) 427-4010
CITY:SACRAMENTOSTATE: CAZIP CODE:
95832
CAPACITY: 44TOTAL ENROLLED CHILDREN: 0CENSUS: 24DATE:
09/02/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Silvia FigueroaTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with the site supervisor, Silvia Figueroa, for a case management inspection for an incident.

The facility self reported that a child swallowed a magnetic marble by accident. During today’s inspection, LPA interviewed the site supervisor about the incident. Per site supervisor, the incident happened in the play yard and there were two teachers present at the time of the incident. Per site supervisor, after learning about the incident, site supervisor contacted the parent of the child and the child was picked up by a family member. Per site supervisor, child has been going normal activities and is in care.

During today’s inspection, no violation of any regulations was observed. Copy of this report is reviewed and provided to the site supervisor. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISORS NAME: Maria Mayorga
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2021
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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