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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623185
Report Date: 12/06/2023
Date Signed: 12/06/2023 12:25:47 PM

Document Has Been Signed on 12/06/2023 12:25 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:SETA - CP HUNTINGTON HEAD STARTFACILITY NUMBER:
343623185
ADMINISTRATOR:SHANNON MATLOCKFACILITY TYPE:
850
ADDRESS:5917 26TH STREETTELEPHONE:
(916) 263-3800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95822
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 27DATE:
12/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Shannon MatlockTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 11:45am for a Plan of Correction inspection regarding the deficiencies cited on LIC809D dated 11/28/2023. LPA met with director, Shannon Matlock. Today’s census was 27 children.

Based upon today’s inspection, LPA’s observed that all deficiencies are cleared as of today.

No Title 22 Deficiencies observed in the areas that were evaluated. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director [or facility representative] Shannon Matlock.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
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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