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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 440710482
Report Date: 10/25/2021
Date Signed: 10/25/2021 02:07:37 PM

Document Has Been Signed on 10/25/2021 02:07 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:ENCOMPASS HEAD STARTFACILITY NUMBER:
440710482
ADMINISTRATOR:ANA TORRESFACILITY TYPE:
850
ADDRESS:255 SWIFT STREETTELEPHONE:
(831) 706-0418
CITY:SANTA CRUZSTATE: CAZIP CODE:
95060
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 21DATE:
10/25/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Ana TorresTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA), Kristal Goodell met with site director Ana Torres for the purpose of a Case Management inspection to deliver Decision in Order for life time exclusion effective 10/25/21 for Shakaim Redroban. Later during the inspection Educator Manager (EM)Lorena Gonzalez joined.

LPA toured both classrooms and outdoor areas. During inspection LPA conducted a census of 15 children napping in preschool classroom with two staff present. LPA observed five children napping in toddler classroom with one staff member present. All individuals subject to criminal background review have obtained a criminal record clearance. Decision in order was issued and updated Personnel Report (LIC500) requested. EM informed LPA that Shakaim's last day at facility was 4/15/21.

No deficiencies cited. Report reviewed and copies issued. Notice of Site Visit issued and must remain posted for 30 days.
SUPERVISORS NAME: Diana Stephenson
LICENSING EVALUATOR NAME: Kristal Goodell
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2021
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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