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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622573
Report Date: 05/31/2022
Date Signed: 05/31/2022 10:10:56 AM

Document Has Been Signed on 05/31/2022 10:10 AM - 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 - 16TH AVENUE HEAD STARTFACILITY NUMBER:
343622573
ADMINISTRATOR:JOUA XIONGFACILITY TYPE:
850
ADDRESS:4104 MARTIN LUTHER KINGJR BLVDTELEPHONE:
(916) 593-5169
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 76TOTAL ENROLLED CHILDREN: 76CENSUS: 32DATE:
05/31/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lynda De La MoraTIME COMPLETED:
10:30 AM
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At 9:15 a.m. on Tuesday, May 31st, 2022, Licensing Program Analysts (LPAs) Lea Habtom and Amanda Blesi met with Program Officer of Education Lynda De La Mora, for the purpose of a case management inspection. Upon arrival, LPAs observed a census of 6 toddlers and 26 preschool children supervised by 7 staff. All individuals subject to criminal background review have obtained criminal record clearance.

The facility wishes to add room #5 and increase the toddler option from 16 to 27 keeping the capacity at 76. The room has 2 toilets and 1 sink. Cubbies were observed in the room and the facility has ordered an extra cubby to accommodate 9 toddlers for the room. The toddler room #5 was previously measured and licensed during the pre-licensing inspection and
none of the other usable space within the facility has changed since be licensed. .

Outdoor Activity Space
The outdoor play area is fenced, and shade is provided. The outdoor activity space was previously measured during
a prelicensing inspection and has not changed.

Effective today, Tuesday, May 31, 2022 LPA is granting a room addition to room #5 and a change in the toddler option from 16 to 27.

There were no deficiencies cited during today's visit. An exit interview was conducted. Notice of Site Visit provided
and shall remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
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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