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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 553621205
Report Date: 05/15/2024
Date Signed: 05/15/2024 11:10:02 AM

Document Has Been Signed on 05/15/2024 11:10 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ATCAA - JAMESTOWN EARLY HEAD STARTFACILITY NUMBER:
553621205
ADMINISTRATOR/
DIRECTOR:		FAVIOLA GARCIAFACILITY TYPE:
850
ADDRESS:10550 SEVENTH STREETTELEPHONE:
(209) 984-1715
CITY:JAMESTOWNSTATE: CAZIP CODE:
95327
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 10DATE:
05/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Ashley JohnsonTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Jennie Tedlos met with Lead Teacher, Ashley Johnson to follow up on the Unusual Incident Report (UIR) submitted to Community Care Licensing on 05/08/24.

LPA toured the facility, observed the care and supervision of children, and conducted interviews.

Facility evaluation report was reviewed and discussed with Lead Teacher Ashley Johnson. Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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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